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All Journal Jurnal Anestesi Perioperatif The Journal of Society Medicine (JSOCMED)
Ridwan, Romi
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Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Case Series of Guillain Barre Syndrome with Plasmaparesis in The ICU Bandung Hospital Ridwan, Romi; Oktaliansyah, Ezra
Journal of Society Medicine Vol. 3 No. 4 (2024): April
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i4.141

Abstract

Background: Guillain-Barré syndrome (GBS) is an autoimmune disease of the peripheral nervous system, which is clinically characterized by tetraplegia with or without sensory disturbances. Manifestations include weakness, progressive muscle areflexia and can cause weakness in the respiratory muscles. This causes sufferers to need mechanical ventilation assistance. ICU complications such as lung infections and sepsis occur if treatment is prolonged. Plasmaparesis in GBS is a therapy other than IVIG (IntraVenous ImmunoGlobulin) administration. Case report: We compared 2 cases, 42 years old (man A) and 31 years old (man B), with respiratory failure due to GBS were treated with plasmaparesis for 5 cycles. Patient A showed faster clinical improvement results. It took 6 days to get off mechanical ventilation on patient A, while on day 11 patient B still needed mechanical ventilation, with persistent tetraparesis. Conclusion: This case highlights the importance of using TCD and NIRS in the intensive care unit as guiding therapies in maintaining patient blood pressure, administering blood components, and early detection of complications such as cerebral vasospasm.
Perbedaan Frekuensi PVA (Patient Ventilator Asynchrony) Pada Beberapa Level Sedasi Pasien Kritis Ridwan, Romi; Suwarman, Suwarman; Kestriani, Nurita Dian Kestriani Dian
Jurnal Anestesi Perioperatif Vol 13, No 3 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v13n3.3987

Abstract

Background: Patient–ventilator asynchrony (PVA) is a frequent but often underrecognized phenomenon in mechanically ventilated patients, associated with adverse outcomes. Sedation depth is a modifiable factor affecting PVA, yet data from resource-limited ICUs remain scarce. This study aimed to evaluate PVA prevalence and its association with sedation depth and mechanical ventilation duration.Methods: A cross-sectional observational study included 60 adult ICU patients on mechanical ventilation. Ventilator waveform recordings were analyzed over 30-minute periods, totaling 41,372 breaths. PVA events were identified, classified, and quantified. Sedation depth was categorized as fully awake, light sedation, or deep sedation. Associations between sedation depth, PVA frequency, and mechanical ventilation duration were assessed using statistical tests.Results: A total of 2,539 PVA events were detected, yielding an overall asynchrony rate of 6.1%. Ineffective effort was most common (58%), followed by double triggering (17.2%) and flow asynchrony (15.3%). Mean PVA values increased significantly with deeper sedation (p<0.05). A weak but statistically significant positive correlation existed between average PVA and duration of mechanical ventilation (r=0.306, p<0.05).Discussion: PVA is prevalent in mechanically ventilated ICU patients, with ineffective effort predominating. Deeper sedation levels are associated with higher PVA frequency, which correlates with prolonged ventilation. These findings emphasize the need for careful sedation management and routine ventilator waveform monitoring to improve patient–ventilator interaction.Conclusion: Patient–ventilator asynchrony is common and significantly associated with sedation depth and ventilation duration. Optimized sedation and vigilant waveform monitoring may enhance synchrony and reduce ventilation time
Co-Authors Ezra Oktaliansyah Kestriani, Nurita Dian Kestriani Dian Suwarman Suwarman, Suwarman