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

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Management of Patients with Guillain Barre Syndrome Accompanied by Ventilator Associated Pneumonia Sihombing, Robert; Pison, Osmond Muftilov
Journal of Society Medicine Vol. 3 No. 5 (2024): May
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i5.144

Abstract

Introduction: Guillain-Barré syndrome (GBS) is one of the most common autoimmune diseases affecting the peripheral nervous system in the world. This disease has manifestations of weakness, progressive muscle areflexia and can cause weakness in the respiratory muscles. This causes the patient to need mechanical ventilation assistance. Pneumonia is one of the most common complications of GBS. Ventilator-Associated Pneumonia (VAP) is one of the common nosocomial infections in 10-20% of patients on mechanical ventilators in the Intensive Care Unit (ICU). The crude mortality rate in patients who develop VAP ranges from 30-70%. In addition, VAP can significantly increase the duration of hospitalisation, as well as the cost of care. Increasing bacterial resistance in today's world makes it difficult to treat VAP with empirical antibiotic therapy. Case: A 44-year-old man came to the hospital with complaints of weakness in four limbs. The patient had previously been treated at another hospital with a diagnosis of GBS, because the patient's Erasmus GBS Respiratory Insufficiency Score (EGRIS) assessment was 5 and required further treatment in the ICU, the patient was referred to the main hospital. The complaint of being unable to move all four limbs was felt since 5 days before admission. The patient was admitted to the previous hospital for two days and received Mecobalamin, Gabapentin, and Ceftriaxone therapy. Conclusion: GBS is a post-infectious autoimmune disease that results in nerve cell destruction. Severe muscle weakness can lead to respiratory failure resulting in the need for mechanical ventilation therapy. Nosocomial pneumonia is a common complication in patients in critical condition and the leading cause of death from nosocomial infections, especially ventilator-associated pneumonia in intubated patients.
Management of Acute Respiratory Distress Syndrome Due to Transfusion-Related Acute Lung Injury and Pulmonary Contusion in a Patient with Moderate Head Injury Post-Craniotomy Decompression, Epidural Hematoma, and Posterolateral Rib Fractures 2-6 Hendro, Rachmad Try; Pison, Osmond Muftilov
Journal of Society Medicine Vol. 4 No. 7 (2025): July
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i7.223

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Introduction: Acute Respiratory Distress Syndrome (ARDS) is characterized by acute onset within seven days of an insult, leading to impaired gas exchange, respiratory distress not attributed to cardiac pump dysfunction, and diffuse bilateral opacities on chest X-ray (CXR). ARDS can result from direct lung parenchymal injury, such as pulmonary contusion, or indirect mechanisms, such as transfusion-related acute lung injury (TRALI), which triggers inflammatory mediator release, causing capillary leakage and damage to type I and II pneumocytes. Case Description: A 50-year-old male was admitted to the Intensive Care Unit (ICU) following a craniotomy evacuation. On the second day of ICU care, after receiving four units of packed red cell (PRC) transfusion and subsequent extubation, the patient developed dyspnea, increased respiratory rate, elevated work of breathing, and desaturation. Clinical examination revealed decreased consciousness, tachycardia, tachypnea, and desaturation. Diagnostic imaging showed diffuse bilateral opacities without cardiac abnormalities. The patient was re-intubated and connected to a ventilator using a lung protective strategy. Broad-spectrum antibiotics and adequate tissue perfusion support were administered. The patient showed improvement and was discharged from the ICU. Conclusion: ARDS, whether caused by direct insults like pulmonary contusion or indirect mechanisms like TRALI, requires a lung protective strategy to preserve healthy lung tissue. Early recognition and appropriate ventilatory management are critical for improving outcomes in such cases.
Red Cell Distribution Width to Albumin Ratio versus Red Cell Distribution Width to Platelet Ratio as Predictors of 28-Day Mortality in Sepsis Patients Admitted to the Intensive Care Unit Ningsih, Diana Fitria; Pison, Osmond Muftilov; Suwarman, Suwarman; Maskoen, Tinni T.; Oktaliansah, Ezra; Aditya, Ricky
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.v13n3.4638

Abstract

Background: Sepsis is a leading cause of mortality in the Intensive Care Unit (ICU). Early identification of high-risk patients requires simple and accessible prognostic biomarkers. The Red Cell Distribution Width to Albumin Ratio (RAR) and Red Cell Distribution Width to Platelet Ratio (RPR) have been proposed as potential biomarkers.Methods: This prospective cohort study was conducted in the ICU of Dr. Hasan Sadikin General Hospital, Bandung, from July to September 2025, involving 71 subjects who met the Sepsis-3 criteria. RAR and RPR values were calculated from blood tests within the first 24 hours of ICU admission. The primary outcome was 28-day mortality. Statistical analysis used the Receiver Operating Characteristic (ROC) curve to determine the cut-off value, sensitivity, specificity, and Area Under the Curve (AUC). The AUC comparison between RAR and RPR was analyzed using the DeLong test.Results: A total of 41 patients (57.7%) experienced 28-day mortality. The optimal cut-off value for RAR was 5.7404 (Sensitivity 85.4%; Specificity 73.3%) with an AUC of 89.3% (95% CI: 79.8–95.4%). The optimal cut-off value for RPR was 0.0627 (Sensitivity 75.6%; Specificity 76.7%) with an AUC of 74.7% (95% CI: 63.0–84.3%). RAR had a significantly better discriminatory value than RPR (p=0.026).Discussion: The RAR value is a better predictor of 28-day mortality than the RPR value in septic patients treated in the ICU.Conclusion: RAR can be considered a simple and effective prognostic tool for the early risk stratification of septic patients.
Co-Authors Ezra Oktaliansah Hendro, Rachmad Try Ningsih, Diana Fitria Ricky Aditya, Ricky Sihombing, Robert Suwarman Suwarman, Suwarman Tinni T. Maskoen