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All Journal Jurnal Anestesiologi Indonesia Majalah Anestesia dan Critical Care Indonesian Journal of Anesthesiology and Reanimation (IJAR) Bioscientia Medicina : Journal of Biomedicine and Translational Research Solo Journal of Anesthesi, Pain and Critical Care Majalah Anestesia & Critical Care (MACC) Jurnal Sehat Indonesia (JUSINDO) Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute Frontiers on Healthcare Research
Manggala, Sidharta Kusuma
Department Of Anesthesiology And Intensive Care, Faculty Of Medicine, Universitas Indonesia, Jakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Veterinary

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Respiratory Failure and Hypercoagulable State in Creutzfeldt-Jakob Disease: A Rare Case Report Celine Kurniawan; Sidharta Kusuma Manggala
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 5, No 1 (2025): April 2025
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v5i1.91846

Abstract

Background:Creutzfeldt-Jakob Disease (CJD) is a rare, rapidly progressive neurodegenerative disorder caused by prion proteins. It is characterized by a variety of neurological symptoms that lead to severe cognitive decline and death. The uniqueness of this case lies in the severe complications of respiratory failure and a hypercoagulable state, which are not commonly highlighted in the literature. Reporting this case underscores the critical need for awareness and management strategies for such complications in CJD patients, which can significantly impact their clinical outcomes and quality of life.Case Illustration:A 69-year-old female presented with progressively worsening neurological symptoms over a short period. Initially, she experienced visual disturbances and hallucinations, followed by a rapid decline in consciousness, the onset of seizures, and myoclonus. Diagnostic investigations, including an electroencephalogram (EEG) and Magnetic Resonance Imaging (MRI), confirmed the diagnosis of Creutzfeldt-Jakob Disease (CJD).As her condition deteriorated, the patient developed pneumonia and septic shock. Excessive salivary secretion, a symptom often overlooked in CJD, led to significant respiratory compromise and failure. She was admitted to the intensive care unit (ICU) and required mechanical ventilation. Due to the prolonged need for ventilation and to manage airway secretions better, a tracheostomy was performed.Management of her respiratory failure involved meticulous care to reduce hypersalivation and prevent micro-aspiration. Regular suctioning of secretions was crucial. Additionally, given her immobility and increased risk of thromboembolism, she received prophylactic heparin to prevent venous thromboembolism. Physiotherapy was initiated to maintain limb mobility, and elastic stockings were used to reduce the risk of deep vein thrombosis.Conclusion:This case report highlights the complex clinical challenges in managing a patient with CJD, particularly the severe respiratory and thromboembolic complications. The comprehensive approach to managing respiratory failure through tracheostomy and proactive measures to prevent thromboembolism was essential in stabilizing the patient. However, the incurable nature of CJD meant that the focus ultimately shifted to palliative care. This case underscores the importance of recognizing and managing secondary complications in CJD to improve patient outcomes and the need for ongoing research into effective treatments for this devastating disease.
Rapid Response Systems as Secondary Responders to In-Hospital Clinical Deterioration: A Four-Year Observational Study Sidharta Kusuma Manggala; Andi Ade Wijaya Ramlan; Dita Aditianingsih; Riyadh Firdaus; Arief Cahyadi; Aino Nindya Auerkari; Noor Hafidz; Luther Holan Parasian; Adhrie Sugiarto; Yoan Devina; Aivi Mujono; Avisa Cetta Cresma
JAI (Jurnal Anestesiologi Indonesia) Vol 18, No 1 (2026): 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.v0i0.80762

Abstract

Background: In-hospital cardiac arrest (IHCA) is a major cause of preventable inpatient mortality, especially in low- and middle-income countries (LMICs) where rapid response systems (RRS) are still developing. Evidence regarding RRS performance in Indonesia is limited. This study evaluated the performance and operational challenges of an institutional RRS over four years at a large tertiary referral hospital in Jakarta.Objective: This study aimed to determine the proportion of immediate survival following RRS activation and to investigate secondary outcomes, including the association between activation indications and mortality, and system-level barriers.Methods: This retrospective observational cohort study included all inpatient RRS activations at Cipto Mangunkusumo National General Hospital (RSCM), Jakarta, Indonesia, from January 1, 2021, to December 31, 2024. Data from the hospital’s RRS registry were analyzed for activation triggers, interventions, immediate outcomes, and operational issues.Results: Among 246,367 inpatient admissions, there were 5,900 eligible inpatient RRS activations, yielding an activation rate of 23.9 per 1,000 admissions. Immediate survival occurred in 4,763 (80.7%) events, while 1,137 (19.3%) patients did not survive. Cardiac arrest (8.0%) and respiratory arrest (6.5%) were the strongest predictors of non-survival odds ratio (OR) 48.17 and 27.13 vs. red early warning score (EWS) reference, both p<0.001). Most activations occurred out of hours (63.0%), and mortality was significantly higher (71.3% vs. 61.1%; p < 0.001). The most frequent single-parameter triggers were oxygen saturation ≤90% (38.5%) and sudden deterioration of consciousness (15.8%). Mismatched activations, where the patient’s condition upon team arrival differed from the activation indicationwere strongly associated with higher mortality (OR 17.3, 95% confidence interval (CI) 14.3–20.2, p<0.001).Conclusion: The institutional RRS demonstrated a moderate activation rate and favorable immediate survival compared with similar LMIC settings. However, outcomes were influenced by delayed recognition, out-of-hours activation, and limited critical-care capacity. Strengthening early-escalation culture, monitoring afferent-limb failure (ALF), expanding nighttime coverage, and increasing intensive care unit (ICU) capacity are essential to enhance RRS effectiveness and reduce preventable in-hospital mortality in resource-limited settings.
Acute Fatty Liver of Pregnancy (AFLP): A Case Report Yustisa Sofirina Harahap; Sidharta Kusuma Manggala
Jurnal Sehat Indonesia (JUSINDO) Vol. 8 No. 2 (2026): Jurnal Sehat Indonesia (JUSINDO)
Publisher : CV. Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/-.v8i2.546

Abstract

Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening obstetric emergency that typically occurs during the third trimester and may lead to acute liver failure in pregnant women. Maternal and fetal mortality rates are substantially increased without prompt diagnosis and treatment; therefore, early recognition and immediate intervention are essential. This case report describes a 34-week pregnant woman who was admitted to the hospital with complaints of nausea, vomiting, heartburn, weakness, and jaundice. Laboratory examinations revealed signs of acute liver failure, including hypoglycemia, elevated liver enzymes, hyperbilirubinemia, severe coagulopathy with disseminated intravascular coagulation (DIC), and thrombocytopenia. The diagnosis of AFLP was established based on the Swansea criteria, with the patient fulfilling ≥6 criteria. The patient was managed in the intensive care unit (ICU), where stabilization was achieved through oxygen therapy, glucose infusion, electrolyte correction, transfusion of blood components, including fresh frozen plasma (FFP) and platelets, to manage DIC, vitamin K administration, and broad-spectrum empirical antibiotic therapy. Once stabilized, an emergency cesarean section was performed at 34 weeks of gestation to prevent further disease progression. The infant was delivered with a birth weight of 2,450 g and Apgar scores of 3 and 5, requiring admission to the neonatal intensive care unit (NICU). Following delivery, the mother’s condition gradually improved, with liver function and coagulation parameters showing improvement within 3–4 days and approaching normal levels within 1 week. Both the mother and infant recovered and were discharged home in good condition.
Effect of Preoperative Lactobacillus acidophilus Supplementation on Postoperative Gastric Residual Volume after Lower Digestive Laparotomy: A Randomized, Double-Blind, Controlled Trial Christophorus Simadibrata; Rudyanto Sedono; Sidharta Kusuma Manggala; Wifanto Saditya Jeo
Frontiers on Healthcare Research Vol. 3 No. 2 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n2.p22-30.2026

Abstract

Background: Gastrointestinal dysmotility is among the most common complications after abdominal surgery and is reflected clinically by an elevated gastric residual volume (GRV), which increases the risk of aspiration and delays enteral feeding. Lactobacillus acidophilus is thought to improve gut motility through luminal acidification, competitive exclusion of pathogens, and direct stimulation of smooth-muscle contractility, but whether this translates into a lower GRV after digestive laparotomy has not been tested. Objective: To determine whether preoperative Lactobacillus acidophilus supplementation reduces postoperative GRV after lower digestive laparotomy. Methods: In this randomized, double-blind, placebo-controlled trial at Dr. Cipto Mangunkusumo National General Hospital, Indonesia, adults scheduled for elective laparotomy of the jejunum, ileum, colon, or rectum received oral Lactobacillus acidophilus 10⁹ CFU or an identical placebo capsule three times daily for three days before surgery. A nasogastric tube inserted during surgery was aspirated every 6 hours after ICU admission; GRV was categorized as normal (<250 mL/24h) or increased (≥250 mL/24h) at 24 and 48 hours. Results: Fifty-five participants were randomized (27 probiotic, 28 placebo); one placebo-group participant was withdrawn because of sepsis, leaving 54 participants analyzed per protocol. GRV was increased in 4/27 (14.8%) probiotic recipients versus 2/27 (7.4%) placebo recipients at 24 hours (p = 0.669; risk ratio for normal GRV 0.92, 95% CI 0.76–1.11) and in 1/27 versus 0/27 at 48 hours (p = 1.000). Stratified analysis identified age, neurological comorbidity, obesity, vasopressor use, opioid exposure, hypercapnia, and hyperglycemia as confounders that shifted the crude risk estimate by more than 10%; opioid and vasopressor exposure were also unevenly distributed between groups at baseline (p = 0.006 and p = 0.026, respectively). Conclusion: A 3-day preoperative course of Lactobacillus acidophilus did not significantly reduce postoperative GRV after lower digestive laparotomy. The trial was underpowered relative to its planned sample size, and an uneven distribution of opioid and vasopressor exposure between groups may have obscured a true effect.
Co-Authors Aivi Mujono Alantas, Anas Andi Ade Wijaya Ramlan Arief Cahyadi Asri C. Adisasmita Astari Karina Auerkari, Aino Nindya Avisa Cetta Cresma Celine Kurniawan Christophorus Simadibrata Dita Aditianingsih Dita Aditianingsih Hafidz, Noor Halim, Ida Juita Ignatia Novianti Tantri Jeo, Wifanto Saditya Kapuangan, Christopher Khadafi Indrawan Kurniawan, Celine Listyana, Tia Luther Holan Parasian Luther Napitupulu Meirina Montolalu, Gabriela Noor Hafidz Perdana, Aries Rahmah, Herlina Ratna Farida Soenarto Riyadh Firdaus Rosdiana, Prita Rudyanto Sedono Septianto Halim Solly Aryza Sugiarto, Adhrie Tantri, Aida Rosita Tasya Claudia Pardede Vera Irawany Wardhani, Yosi Dwi Yoan Devina Yustisa Sofirina Harahap Zahrina, Fadiah