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All Journal Solo Journal of Anesthesi, Pain and Critical Care Cermin Dunia Kedokteran
Rikardi, Fachrizal
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Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health

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Thromboprophylaxis in Intensive Care Unit Patients Rikardi, Fachrizal; Fitriani R.W, Calcarina
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 4, No 2 (2024): October 2024
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v4i2.93687

Abstract

Background: Intensive Care Unit (ICU) patients are at twice the risk of experiencing thrombosis compared to patients in regular wards. This risk is associated with prolonged immobility, sedation, and neuromuscular blockade to facilitate ventilation. The incidence ranges from 8-40%. This undoubtedly leads to poorer patient outcomes, including increased patient mortality. ICU patients require prophylaxis to prevent thrombotic events. The use of thromboprophylaxis has been shown to reduce mortality rates in these patients.Content: Intensive Care Unit (ICU) patients are at risk of developing thrombosis, which is closely related to Virchow's triad, which consists of venous stasis, endothelial dysfunction, and hypercoagulability. Considering the high morbidity associated with thrombotic events and the low side effects of carefully administered anticoagulants, pharmacological prophylaxis should be provided to all critically ill patients without contraindications to anticoagulants. Regular monitoring is necessary when administering pharmacological prophylaxis. Compared with UFH and mechanical compression, LMWH is the preferred thromboprophylaxis for ICU patients. Generally, patients weighing 50-100 kg can be given LMWH, such as enoxaparin, at a subcutaneous dose of 40 mg per day. The discontinuation of thromboprophylaxis should consider the patient's clinical condition and drug side effects.Summary: Thromboprophylaxis is highly necessary for Intensive Care Unit (ICU) patients. The preferred thromboprophylaxis for ICU patients is LMWH. In certain circumstances, UFH or mechanical thromboprophylaxis may be considered.
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.
Co-Authors Bowo Adiyanto Fitriani R.W, Calcarina