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All Journal Jurnal Anestesiologi Indonesia Indonesian Journal of Anesthesiology and Reanimation (IJAR) Journal of Anaesthesia and Pain Majalah Anestesia & Critical Care (MACC) Jurnal Medika Nusantara The International Journal of Medical Science and Health Research Jurnal Komplikasi Anestesi Cermin Dunia Kedokteran
Bowo Adiyanto
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran, Kesehatan Masyarakat Dan Keperawatan, Universitas Gadjah Mada, Yogyakarta, Indonesia
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Hubungan Antara Tingkat Keparahan dan Jenis Terapi Oksigen Terhadap Kualitas Hidup Penyintas Covid-19 yang Pernah Dirawat Di ICU RSUP Dr Sardjito wandito, Gayuh Utomo; Wisudarti, Calcarina Fitriani Retno; Adiyanto, Bowo
Jurnal Komplikasi Anestesi Vol 11 No 1 (2023)
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.v11i1.12436

Abstract

Latar Belakang: Proses infeksi COVID-19 dapat meninggalkan gejala sisa, sehingga dapat mempengaruhi kualitas hidup penyintasnya, terutama pada penyintas COVID-19 dengan derajat sedang, berat dan kritis. Pasien yang pernah mendapatkan perawatan di ruangan ICU dengan terapi oksigen beragam, memiliki kualitas hidup yang lebih rendah. Tujuan: Mengetahui hubungan antara tingkat keparahan dan jenis terapi oksigen terhadap kualitas hidup penyintas COVID-19 yang pernah dirawat di ICU RSUP dr Sardjito. Metode Penelitian: Jenis dan rancangan penelitian ini adalah observasional kohort prospektif. Peneliti mengambil data sekunder dari rekam medis pada pasien yang terkonfirmasi COVID-19 derajat sedang, berat, kritis dan mendapatkan terapi oksigen yang pernah dirawat di RSUP Dr. Sardjito Yogyakarta dan kualitas hidup diukur dan menggunakan kuesioner EQ-5D-5L secara langsung pada saat penelitian. Subjek penelitian adalah seluruh penyintas COVID-19 yang pernah dirawat di ICU RSUP dr Sardjito bulan Januari 2020 sampai dengan Desember 2021. Analisis bivariat untuk menganalisis hubungan hubungan antara tingkat keparahan dan jenis terapi oksigen terhadap kualitas hidup adalah uji Kruskal Wallis. Variable yang memiliki p < 0,25 pada uji bivariat dilanjutkan analisis multivariat dengan uji regresi linier berganda. Hasil: Total subjek penelitian yang memenuhi kriteria adalah 56 subjek. Skor EQ-5D-5L pada pasien dengan suplementasi oksigen dengan , nasal kanul 0.82, non-rebreathing mask 0.96, High Flow Nasal Canule 0.53 dan ventilator 0.81 yakni (p=0,115). Skor EQ-5D-5L pada COVID-19 derajat sedang 0.92, derajat berat 0.92, sedangkan derajat kritis, yakni 0,75 (p=0,254). Kesimpulan: Tidak terdapat hubungan antara tingkat keparahan dan jenis terapi oksigen terhadap kualitas hidup penyintas COVID-19 yang pernah dirawat di ICU RSUP dr Sardjito. Kata Kunci: COVID-19, derajat keparahan, terapi oksigen, kualitas hidup
Apakah Sepsis Perlu Dilakukan CRRT Suparno Suparno; Bowo Adiyanto
Jurnal Medika Nusantara Vol. 2 No. 4 (2024): November : Jurnal Medika Nusantara
Publisher : Stikes Kesdam IV/Diponegoro Semarang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59680/medika.v2i4.1585

Abstract

Sepsis is a condition of systemic inflammation due to dysregulation of the immune system against infection which causes multiorgan failure. One of the most frequent complications of sepsis and has a high mortality rate is acute renal failure (AKI). Often, sepsis that has already occurred requires renal replacement therapy (RRT). The continuous renal replacement therapy (CRRT) technique is currently more widely used than other techniques, namely intermittent hemodialysis (IHD). IHD often causes hemodynamic problems and even causes cardiac arrest in patients who experience hemodynamic disorders in the ICU. Apart from being useful in AKI, CRRT is also useful in eliminating mediators in sepsis. This aims to reduce the severity of cytokine storms and pro-inflammatory endotoxins thereby improving patient outcomes. Several methods and devices such as high cut-off membranes, Oxiris®-AN69 membranes, CytoSorb® and HA380 cytokine hemoadsorption, polymyxin B endotoxin adsorption and plasmapheresis have been widely observed as ways to improve outcomes in septic patients. However, until now data regarding actual benefits is still controversial. This article reviews the benefits and standard operational procedures of RRT in sepsis patients.
THE RELATIONSHIP OF LACTATE-ALBUMIN RATIO TO MORTALITY AND LENGTH OF STAY IN SEPSIS PATIENTS AT ICU DR. SARDJITO GENERAL HOSPITAL Pasmawati, Desti; Wisudarti, Calcarina Fitriani Retno; Adiyanto, Bowo
Jurnal Komplikasi Anestesi Vol 12 No 1 (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.v12i1.15961

Abstract

Background : Sepsis is one of the causes of morbidity and mortality patients hospitalized in the intensive care unit (ICU) which requires early detection and management to predict outcomes. An increase in lactate together with decrease in albumin is encountered in severe inflammatory states. Lactate-albumin ratio has a predictive value of mortality in patient with sepsis that is similar to APACHE II and SOFA scores. These biomarkers can be done quickly, affordable, and available in many hospitals in Indonesia. Objective : To determine the relationship between the lactate-albumin ratio and mortality and length of stay patient with sepsis in ICU of Dr. Sardjito Hospital. Method : Research design using a retrospective cohort observational study method by collecting data from the medical records of sepsis patients treated at ICU of Dr. Sardjito Hospital. Data on lactate and albumin in plasma levels at admission and mortality events were collected to calculate the optimal cutoff using the ROC curve. The relationship between lactate-albumin ratio levels and mortality was analyzed using the chi-square test method followed by logistic regression in multivariate analysis. Results : The total study subjects were 136 patients, wuth a median age of 55 years. The cut-off value for the Lactate-Albumin ratio in predicting mortality was found to be 0,878, with a sensitivity of 73.0 % and a specificity of 57.1% (AUC = 0,687; 95% CI 0,56-0,81; p=0,007). The cut-off value for the Lactate-Albumin ratio in predicting ICU length of stay was found to be 0,878, sensitivity 71,2% and specificity 63,6% (AUC = 0,684; 95% CI 0,53-0,84; p=0,043). Multivariate analysis showed that an increase in the Lactate-Albumin ratio was an independent and significant factor as a predictor of mortality (OR=3,43; 95% CI 1,29-9,16; p=0,013) and ICU length of stay (OR=4,33; 95% CI 1,19-15,68; p=0,036). Age, sex, hypertension, diabetes mellitus, cancer, obesity, and cerebrovascular disease were not independently associated with mortality dan ICU length of stay. Conclusion : An increase in the Lactate-Albumin ratio is independently and significantly associated with an increased risk of mortality and length of stay in sepsis patients.
Literature Review: Palliative Care in Intensive Care Units Akhsaniati, Novi Dwi; Adiyanto, Bowo
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.v0i0.62195

Abstract

Palliative care is defined as care with an approach that improves the quality of life of patients and their families in dealing with problems associated with life-threatening illnesses. As many as 75% of patients treated in the intensive care unit experience unpleasant symptoms. Various studies have shown that palliative care can reduce symptoms caused by invasive procedures in intensive care units and can provide end-of-life care. Thus, assisting patients proactively, decision-making with families, prospects for continued care planning and possible scenarios for end-of-life decisions are essential in intensive care units (ICUs). The integration of palliative care is an important part of comprehensive critical patient care. Critical care providers are often asked to provide pain relief to critically ill patients, hold family meetings to clarify the goals of care, deliver bad news, or provide end-of-life care and care for critically ill patients while providing support to their loved ones. Most ICU patients who are unable to make decisions rely on their families or carers for clinical decision making. Decision making for cardiopulmonary resuscitation, cessation of life-sustaining treatment (LST), and provision of artificial nutrition and hydration should be based on the patient's willingness to discontinue LST, with the involvement of family members and the multidisciplinary team, ensuring that decisions are aligned with the patient's values and goals. The application of palliative care in ICU care can relieve symptoms experienced by patients and can reduce unnecessary invasive procedures. In its application, decision making in palliative care must be based on ethical principles and involve the patient's family, and the decisions made must also be in line with the wishes and values of the patient. The application of palliative care focuses on good symptom management to reduce patient suffering.
Nutrition Therapy in Post-Hartmann’s Procedure Patients in The Intensive Care Unit Palupi, Isnafianing; Adiyanto, Bowo; Wisudarti, Calcarina Fitriani Retno
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (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.v0i0.67337

Abstract

Background: The Hartmann procedure is a surgical procedure for treating colorectal cancer that is widely used in emergencies because it is fast and has a minimal risk of anastomotic leakage. This procedure is usually performed on rectosigmoid cancer. Colorectal cancer patients who undergo gastrointestinal surgery are considered at risk of malnutrition, so adequate nutritional therapy is needed.Case: We report a 51-year-old male patient who came to the intensive care unit (ICU) with an unconscious condition, was intubated, received Norepinephrine support, and had a reddish black product in the nasogastric tube (NGT). The patient was referred with a diagnosis of post-operative Hartmann’s procedure day-3 (D-3) for indications of high obstructive ileus due to rectosigmoid tumor, septic shock, acute kidney injury (AKI), and peptic ulcer. During treatment in the ICU, the patient received antibiotic therapy (Meropenem and Metronidazole), proton pump inhibitors (PPIs), and parenteral nutrition via a central venous catheter (CVC).Discussion: Parenteral nutrition was given from the beginning of admission to the ICU because oral and enteral nutrition could not be provided due to gastrointestinal bleeding (peptic ulcer). Moreover, the patient was considered at risk of malnutrition with evidence of critical illness more than 48 hours post-gastrointestinal surgery due to cancer. Also, there was a post-operative fasting period, usually for several hours to 1-2 days, depending on the patient's condition.Conclusion: Nutritional therapy, as part of the management of critically ill patients, should be given at the right time, in the most effective way, and in appropriate doses for each individual to avoid malnutrition during treatment.
Strategi Evakuasi pada Kebakaran di Unit Perawatan Intensif di Indonesia Purnomo, Ika Cahyo; Prasamya, Erlangga; Adiyanto, Bowo
Majalah Anestesia & Critical Care Vol 43 No 1 (2025): Februari
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i1.425

Abstract

Latar Belakang: Intensive Care Unit (ICU) merupakan unit di mana pasien dengan penyakit kritis dirawat di rumah sakit. Kebakaran di ICU berpotensi menimbulkan ancaman signifikan terhadap keselamatan pasien dan petugas karena kondisi kritis pasien dan kompleksitas peralatan medis yang digunakan. Tinjauan literatur ini bertujuan untuk mengkaji strategi evakuasi ICU yang efektif selama keadaan darurat kebakaran. Metode: Pencarian terhadap artikel ilmiah yang diterbitkan antara tahun 2000 dan 2024, yang membahas protokol, tantangan, dan keluaran evakuasi ICU pada bencana kebakaran melalui Google Scholar dan Pubmed. Hasil pencarian dibandingkan dengan peraturan dan perundangan yang berlaku di Indonesia dan dianalisis secara kualitatif untuk mendapatkan strategi yang mampu laksana di Indonesia. Hasil: Berbagai komponen diperlukan untuk strategi evakuasi kebakaran ICU yang efektif. Pendekatan strategi evakuasi kebakaran di ICU dimulai dari perencanaan respons bencana, pembuatan protokol, koordinasi dan komunikasi, pelatihan dan simulasi, serta perbaikan berkelanjutan terhadap protokol. Berdasarkan literatur yang ada dan peraturan perundangan yang berlaku, kami menyusun suatu strategi pendekatan komprehensif untuk evakuasi ICU pada bencana kebakaran di Indonesia. Simpulan: Keberhasilan evakuasi pasien di ICU memerlukan strategi multi-aspek yang disusun berdasarkan kesiapan fasilitas, kompetensi staf, penerapan protokol yang efektif, serta evaluasi berkelanjutan melalui simulasi dan analisis pasca evakuasi.
Trakeostomi Dilatasi Perkutan dengan Bimbingan Ultrasonografi Waktu Nyata pada Pasien Kritis III: Laporan Kasus Rikardi, Fachrizal; Adiyanto, Bowo
Cermin Dunia Kedokteran Vol 52 No 8 (2025): Penyakit Dalam
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v52i8.1392

Abstract

Introduction: Tracheostomy is a common procedure in intensive care units for critically ill patients with mechanical ventilation. Case: This case report describes the use of real-time ultrasonography (USG) guidance for percutaneous dilatational tracheostomy (PDT) in a 63-year-old female with prolonged mechanical ventilation following craniotomy. The patient had relative contraindications including short neck and morbid obesity (BMI 40.8). On day 7 of ICU admission, a PDT was successfully performed using real-time ultrasonography (USG) guidance. USG was utilized to identify key anatomical landmarks, such as tracheal rings and vascular structures, ensuring safe and accurate needle placement. The use of real-time USG significantly reduced the risk of complications including hemorrhage, tracheal injury, or pneumothorax. The procedure was completed without incident, and the patient showed clinical improvement post-intervention, including enhanced respiratory function and gradual weaning from mechanical ventilation. Conclusion: This report highlights the safety and efficacy of USG-guided PDT, especially in high-risk patients with difficult neck anatomy. It also underlines the importance of ultrasound as a widely available and cost-effective tool in ICU settings. The case supports further implementation of real-time USG-guided techniques in percutaneous tracheostomy to improve procedural success and patient outcomes. Further research involving a larger cohort is needed to establish standardized protocols and evaluate long-term outcomes of this approach.
The Role of Intravenous Immunoglobulin in Myasthenic Crisis: A Case Report of Successful Management in an Elderly Patient with Thymoma Hanafia, Mochamad Fauzi; Adiyanto, Bowo
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.2025.006.03.04

Abstract

Background: Myasthenic crisis represents the most severe and life-threatening manifestation of myasthenia gravis, affecting approximately 15-20% of patients, with mortality rates ranging from 2-16% globally. Intravenous immunoglobulin (IVIG) is emerging as a primary therapeutic modality alongside plasmapheresis for crisis management. The optimal treatment approach in elderly patients with concurrent thymoma remains challenging due to increased perioperative risks and complex clinical presentations. The present case report describes the successful management of myasthenic crisis in an elderly patient with thymoma using intensive IVIG therapy in conjunction with timely surgical interventionCase: A 71-year-old male with established myasthenia gravis presented with myasthenic crisis two days prior to scheduled thymectomy. Clinical manifestations included respiratory distress, bilateral ptosis, drooping head, and dysphonia requiring immediate intensive care management. The patient received three cycles of IVIG therapy (0.4 g/kg/day for 5 days each cycle) in the intensive care unit in conjunction with mechanical ventilation, corticosteroids, pyridostigmine, and urgent thymectomy. Treatment resulted in successful weaning from mechanical ventilation after 8 days, with complete clinical recovery and transfer to the general ward without complications.Conclusion: This case demonstrates the efficacy and safety of intensive IVIG therapy in managing myasthenic crisis in elderly patients with thymoma. The systematic administration of multiple IVIG cycles proved effective in stabilizing respiratory function and facilitating successful surgical intervention, supporting IVIG as a cornerstone therapy in critical care management of severe myasthenia gravis.
Intensive Care Management of a Patient With Pickwickian Syndrome, Obesity, and Congestive Heart Failure Cakradwipa, Mada Oktav; Adiyanto, Bowo; Prasamya, Erlangga
JAI (Jurnal Anestesiologi Indonesia) Publication In-Press
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.74300

Abstract

Background: Pickwickian Syndrome is a condition of alveolar hypoventilation characterized by hypercapnia due to decreased ventilatory drive and capacity caused by obesity. The prevalence of this syndrome aligns with the increasing obesity rate in various countries, especially developed nations, and is associated with obstructive sleep apnea (OSA). Individuals with OSA have a 20–30% risk of developing Pickwickian Syndrome.Case: A 36-year-old male, weighing 160 kg and height 168 cm (body mass index (BMI): 56.69 kg/m²), presented with progressive dyspnea for one week. He had a history of hypertension and heart disease, managed with medication. On arrival at the emergency department (ED), he showed signs of hypoxemia with SpO₂ 80%, which improved to 97% after oxygen therapy with a non-rebreathable breathing mask at 10 L/min. Blood gas analysis revealed partially compensated respiratory acidosis. A Chest X-ray showed bilateral pulmonary edema and cardiomegaly. A diagnosis of Pickwickian Syndrome with congestive heart failure was established. The patient was managed in the intensive care unit (ICU) for 13 days with non-invasive ventilation (NIV) as ventilatory support.Discussion: This case illustrates the complex interplay among morbid obesity, hypoventilation, and cardiac dysfunction. Obesity leads to increased airway resistance and impaired thoracic compliance, resulting in reduced effective ventilation and CO₂ retention. When combined with congestive heart failure, pulmonary edema, and further hypoxemia may ensue. The successful outcome in this case underlines the importance of early diagnosis, targeted respiratory support, and effective fluid management.Conclusion: Intensive care of the patients with Pickwickian Syndrome and congestive heart failure requires a holistic multidisciplinary approach. Optimizing oxygenation, maintaining strict fluid balance, and administering appropriate pharmacologic therapy are crucial to preventing complications and improving prognosis. 
Developing an Effective Team-Based Emergency Training Program for Medical Students Hartono, Pinter; Adiyanto, Bowo; Nur, Rifdhani Fakhrudin; Ancilla, Cornelia; Rahma, Aulia Zuhria
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 1 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I12024.1-13

Abstract

Introduction: Team-based patient management in critical care demands a knowledgeable, skillful, and responsive doctor who collaborates well on teams. Medical education is responsible for producing competent graduates who meet the above requirements. However, the current medical curriculum in Indonesia tends to focus only on individual knowledge and appraisal. There was no standardized university-based group emergency training and examination with comprehensive emergency topics beyond cardiac and trauma cases. Objective: This study aimed to develop and evaluate a team-based emergency training program that enhances medical students' preparedness and teamwork skills in dealing with future emergencies in the workplace. Methods: We developed Acute Life Threatening Events Management (ALTEM), a three-day emergency training program consisting of pre-test, lectures, guided skill practice, group (case-based) simulation exam, and post-test. Group simulation occurred in a virtual hospital with high-fidelity mannequins, actual medical equipment (i.e., beds, monitors, drugs, tools, pads), two-way mirror rooms, and simulated patient family to resemble real hospital situations. The program was then evaluated by a modified Kirkpatrick evaluation model, which measures individual perception, satisfaction, understanding, and performance related to the program. Results: A total of 114 participants were involved in this study. Most subjects (>80%) had a good experience with the program. ALTEM training program significantly increased communication and teamwork (p <0.001) and decision-making towards critical patients (p <0.001) in the univariate analysis. Communication and teamwork remained related considerably in the multivariate analysis (aOR 7.866; p = 0.005). Conclusion: The ALTEM simulation program obtained a good response from the subjects and was a prospective program to improve medical students' competence and teamwork skills in emergencies.
Co-Authors Adiyatma, Krisna Hario Akhmad Yun Jufan Akhsaniati, Novi Dwi Ancilla, Cornelia Aprianti, Tutut Arif Setyo Wibowo Arifin, Achmad Reza Bhirowo Yudo Pratomo Cakradwipa, Mada Oktav Calcarina Fitriani Retno Wisudarti Djayanti Sari Hanafia, Mochamad Fauzi Harianto, Widi Yuli Hartono, Pinter Hernawan, Agung Diky IG Ngurah Rai Artika Ika Cahyo Purnomo Joni, Rendy Pranda Juni Kurniawaty Muhdar Abubakar Djayanti Sari Maryani, Nova Naomi, Diah Anis Nur, Rifdhani Fakhrudin Palupi, Isnafianing Pambudi, Estu Agung Pasmawati, Desti Prasamya, Erlangga Rahma, Aulia Zuhria Rikardi, Fachrizal Sadewo, Yuri Sarjono, Pramuditya Haryo Shila Suryani, Shila Sofwan, Fachruddin Sudadi Suparno Suparno Sutiyoso, Noor Aditya Suwarman Untung Widodo, Untung wandito, Gayuh Utomo Wijaya, Andryadi