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All Journal SAINS MEDIKA : JURNAL KEDOKTERAN DAN KESEHATAN Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Indonesian Journal of Anesthesiology and Reanimation (IJAR) Journal of Anaesthesia and Pain Jurnal Kesehatan Tambusai Solo Journal of Anesthesi, Pain and Critical Care Ahmad Dahlan Medical Journal The International Journal of Medical Science and Health Research Jurnal Komplikasi Anestesi
Akhmad Yun Jufan
Department Of Anesthesiology And Intensive Therapy, Faculty Of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Veterinary

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Peran Ultrasound Guided Vascular Access (UGVA) dalam Menurunkan Risiko Komplikasi Central Line-associated Bloodstream Site Infection (CLaBSI) Yun Jufan, Akhmad
Jurnal Komplikasi Anestesi Vol 11 No 2 (2024): Volume 11 Number 2 (2024)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i2.13316

Abstract

Central Line-associated Bloodstream Infection (CLaBSI) is a complication of infection that occurs when bacteria enter the bloodstream through a central venous catheter. CLaBSI is diagnosed by doctors through blood culture results and from the tip of the central venous catheter. Infections related to central venous catheters such as CLaBSI can lead to serious complications including sepsis, septic shock, and death. To reduce the incidence of CLaBSI, several prevention can be taken during central venous catheter insertion, one of which is using Ultrasound-Guided Vascular Access (UGVA) technique. This article aims to compare the effectiveness and safety of using the Ultrasound-Guided Vascular Access (UGVA) method with the landmark method in preventing Central Line-associated Bloodstream Infection (CLaBSI). The writing method used is literature review with keywords CLaBSI, USG guided, and central line catheter. The results show that the use of UGVA can reduce the incidence of CLaBSI to be two times lower compared to the landmark technique.
Prevention and Management of Stress Ulcers in Critically ill Patients Zulfakhri, Zulfakhri; Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.61232

Abstract

Stress ulcers or stress related mucosal damage (SRMD) is a term defining inflammation, erosion, and ulceration in the upper gastrointestinal tract complicating patients with critical illness. Stress ulcers occur because of imbalance between the aggressive factors in stomach (gastric acid, pepsin, and bile salt) and the defensive factors (mucous, bicarbonate, microcirculation, epithelial layer, and prostaglandin). The most common clinical feature of stress ulcers is upper gastrointestinal tract bleeding in which the incidence rate is 2.6% in critically ill patients. Stress ulcers commonly happen after a gastrointestinal mucosal break in 75–100% of intensive care unit (ICU) patients in the first 24 hours of admission. The classification of stress ulcers includes asymptomatic stress ulcers, stress ulcers with occult and overt bleeding, and stress ulcers with clinically significant gastrointestinal bleeding. The diagnosis of stress ulcers can be made by assumption only and do not need an endoscopy. Some cases of stress ulcers that need an endoscopy are patients with overt and clinically significant gastrointestinal bleeding stress ulcers. Thus, the treatment of stress ulcers is similar to upper gastrointestinal bleeding. Stress ulcers can be prevented by administering stress ulcers prophylaxis such as histamine H2 receptor antagonist, proton pump inhibitor, cytoprotective agent (sucralfate), and usage of enteral feeding method.
Predictors of Severity and Management of Severe Leptospirosis Patients in Intensive Care Unit Kusumawardani, Dwi Indriati; Jufan, Akhmad Yun
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 1 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.62735

Abstract

Background: Severe leptospirosis or Weil's syndrome occurs in 10% of leptospirosis cases, with a mortality rate of 5-40%. Misdiagnosis of leptospirosis often occurs due to nonspecific symptoms. Discussion of risk factors, causative agents, pathogenesis, clinical manifestations, diagnostic techniques, and predictors of disease severity are crucial for successful management.Cases: We report 3 cases of leptospirosis with various clinical manifestations and management. In these 3 cases, older age was associated with severe leptospirosis and poor outcomes. The SPiRO score can identify patients with severe leptospirosis requiring intensive care. All three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the intensive care unit (ICU).Discussion: Early and appropriate management can reduce patient mortality rates. ICU management of leptospirosis includes antibiotics, fluid balance, and support for affected organs. Patients with respiratory failure are given oxygenation using high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation with endotracheal intubation (ETT). Acute kidney failure in leptospirosis can be managed with hemodialysis as indicated or may improve with conservative therapy. Corticosteroids may be administered for thrombocytopenia associated with leptospirosis.Conclusion: The three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the ICU. Early and appropriate management can reduce patient mortality rates. In these 3 cases, older age, mechanical ventilation, acute kidney failure, septic shock, thrombocytopenia, and elevated transaminase enzymes were associated with severe leptospirosis and poor outcomes.
MANAJEMEN ARDS PADA PASIEN SINDROM MEIGS DI ICU hanafia, mochamad fauzi; Jufan, Akhmad Yun; Prasamya, Erlangga
Jurnal Kesehatan Tambusai Vol. 6 No. 2 (2025): JUNI 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i2.45875

Abstract

Sindrom Meigs merupakan tumor jinak ovarium disertai asites dan efusi pleura yang dapat memicu komplikasi sistemik, termasuk Acute Respiratory Distress Syndrome (ARDS). Laporan ini membahas tantangan tatalaksana ARDS pada pasien sindrom Meigs dengan kontraindikasi operasi akibat instabilitas hemodinamik. Pasien dirujuk dengan rencana operasi pengangkatan tumor ovarium, namun mengalami perburukan kondisi akibat efusi pleura masif, hipoalbuminemia (2,53 g/dL), dan syok septik. Kriteria ARDS berat (rasio PaO₂/FiO₂ 85,71) ditegakkan berdasarkan analisis gas darah dan pencitraan toraks. Tatalaksana meliputi ventilasi mekanik mode Synchronized Intermittent Mandatory Ventilation (SIMV) dengan Positive End-Expiratory Pressure (PEEP) 5-8 cmH₂O dan tidal volume 4-6 mL/kgBB ideal (191-287 mL), terapi antibiotik meropenem, koreksi hipoalbuminemia dengan albumin 20%, serta nutrisi enteral dan parenteral. Manajemen ARDS pada sindrom Meigs memerlukan pendekatan multidisiplin dengan fokus pada optimasi ventilasi protektif, koreksi gangguan onkotik, dan kontrol infeksi. Meskipun protokol tatalaksana sesuai pedoman, prognosis tetap ditentukan oleh respons individu terhadap terapi dan komorbiditas penyerta.
MANAJEMEN PASIEN DENGAN SYOK SEPSIS, CONGESTIVE HEART FAILURE, CORONARY ARTERIAL DISEASE, CHRONIC KIDNEY DISEASE POST FISTULEKTOMI DI ICU wijaya, andryadi; Jufan, Akhmad Yun; Prasamya, Erlangga
Jurnal Kesehatan Tambusai Vol. 6 No. 2 (2025): JUNI 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i2.45876

Abstract

Sepsis merupakan kondisi disregulasi sistem imun akibat infeksi dengan angka mortalitas tinggi yang dapat mencapai 26%. Komplikasi seperti Acute Kidney Injury dapat meningkatkan risiko kematian hingga 50%. Masalah utama dalam manajemen sepsis adalah kompleksitas penanganan pasien dengan komorbid multipel seperti gagal jantung kongestif (CHF) dan chronic kidney disease (CKD). Tujuan penelitian ini adalah mengevaluasi manajemen dan luaran klinis pasien dengan syok sepsis disertai komorbid CHF dan CKD post fistelektomi di ruang intensif. Kasus: Pasien menjalani fistelektomi drainase dan dirawat di ICU dengan dukungan ventilasi mekanik, vasopresor (norepinefrin, dobutamin, epinefrin), dan antibiotik spektrum luas (meropenem). Pemeriksaan laboratorium menunjukkan leukositosis signifikan, anemia, hipoalbuminemia, serta gangguan fungsi hati dan ginjal. Setelah empat hari perawatan intensif dengan monitoring hemodinamik ketat, pasien menunjukkan perbaikan klinis, berhasil diekstubasi, dan direncanakan pindah ke ruang perawatan biasa. Simpulan: Manajemen pasien dengan syok sepsis disertai komorbid CHF dan CKD memerlukan pendekatan multidisiplin yang komprehensif. Kontrol sumber infeksi melalui pembedahan, terapi sepsis sistematis, dan pemantauan ketat di ruang intensif berperan penting dalam meningkatkan luaran klinis dan survival pasien.
Multidisciplinary Management of Severe Hemorrhagic Stroke with Triple Challenge: Subarachnoid Hemorrhage, Intracerebral Hemorrhage, and Hydrocephalus-A Case Report Wijaya, Andryadi; Jufan, Akhmad Yun
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2025.006.03.05

Abstract

Background: Hemorrhagic stroke, particularly subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), is a neurological emergency associated with high morbidity and mortality, especially when complicated by increased intracranial pressure (ICP). This report aims to describe the comprehensive management of a patient with severe hemorrhagic stroke complicated by SAH, ICH, and hydrocephalus Case: This case report describes the management of a 69-year-old female with extensive SAH, ICH, ruptured anterior communicating artery aneurysm, and obstructive hydrocephalus. The patient presented with decreased consciousness post-seizure. Initial management included emergency external ventricular drain (EVD) placement and subsequent surgical clipping of the aneurysm. Non-invasive ICP monitoring using optic nerve sheath diameter (ONSD) demonstrated a reduction from 0.68 cm to 0.49 cm over seven days, reflecting successful ICP control. Complications included vasospasm managed with nimodipine, hypernatremia and polyuria suggestive of central diabetes insipidus treated with desmopressin, and nosocomial pneumonia due to serratia marcescens. Antibiotic therapy was escalated from ceftriaxone to meropenem and de-escalated to cefepime based on culture results. Despite optimal intensive care, the patient showed no significant neurological improvement (persistently low Glasgow Coma Scale [GCS]) and failed ventilator weaning. Given a poor prognosis (WFNS grade 4, Hunt & Hess grade 4, ICH score 3), the patient was transitioned to palliative care.  Conclusion: This case highlights the importance of multidisciplinary management, non-invasive ICP monitoring, and timely transition to palliative care in severe hemorrhagic stroke.
Co-Authors Adi Wibowo Adiyatma, Krisna Hario Adrin, Olga Elenska Al-Munawar, Nira Muniroh Anwar, Yusuf ‘Alim Musthofa Apriyanto Arifin, Achmad Reza Atmanagara, Dikho Bahrun, Nugraha Septian Bhaktiyar, Agung Bhirowo Yudo Pratomo Bowo Adiyanto Calcarina Fitriani Retno Wisudarti Dewi, Baiq Dessy Resmana Dian Ayu Listiarini Djayanti Sari Fauzi, Rizqi Ahmad Febrianti, Skolastika Rani Firman Ardiansyah FRW, Calcarina Hanafi, Irham Hanafia, Mochamad Fauzi Hartono, Pinter helen yudi irianto Helen Yudi Irianto Indra Wijaya, Adi Juni Kurniawaty Muhdar Abubakar Djayanti Sari Kuncoro, Kusuma Edhi Kusuma, Danur Adi Kusumawardani, Dwi Indriati Mahardieni, Karlina Maryani, Nova Nova Maryani Pradana, Gilar Rizki Aji Prasamya, Erlangga Pratama, Andhika Marthsyal Ratih Kumala Fajar Apsari Rayhandika Sari, Dhanty Dwita Sarosa, Pandit Sudadi Sulistiyantoro, Antonius Catur Sunantara, I Gusti Ngurah Putu Mandela Teguh Setiadi Trijayanti, Christiana Untung Widodo Untung Widodo Untung Widodo, Untung Utami, Vengky Wibowo, Catur Prasetyo Wibowo, Erry Alamsyah Asjhuri Wijaya, Andryadi Yuliani, Irma Yunita Widyastuti Yusmein Uyun Zulfakhri, Zulfakhri