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All Journal Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif Majalah Anestesia dan Critical Care Multidiciplinary Output Research for Actual and International Issue (Morfai Journal) The Journal of Society Medicine (JSOCMED)
Budiana Rismawan
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/ Rumah Sakit Dr. Hasan Sadikin Bandung
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Uji Kesesuaian Pengukuran Berat Badan antara Metode Lorenz dan Metode Modifikasi PAWPER-XL MAC dengan Tempat Tidur Bertimbangan Khusus Pamugar, Bramantyo; Suwarman, Suwarman; Rismawan, Budiana
Jurnal Anestesi Perioperatif Vol 12, No 3 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v12n3.3826

Abstract

Berat badan aktual sangat penting di Intensive Care Unit (ICU). Baku standar penilaian berat badan aktual adalah timbangan khusus, namun timbangan ini tidak banyak tersedia di ICU. Alternatif lain untuk estimasi berat badan aktual dapat menggunakan metode antropometrik. Penelitian ini merupakan uji kesesuaian antara estimasi berat badan aktual menggunakan metode Lorenz dan modifikasi PAWPER-XL MAC dengan berat badan aktual menggunakan timbangan khusus baku standar. Penelitian ini adalah analitik observasional dengan potong lintang pada 83 pasien ICU rumah sakit Hasan Sadikin Bandung antara Agustus hingga November 2023. Uji kesesuaian menggunakan: uji t, P10, P20, mean percentage error (MPE), dan limit of agreement (LOA). Pasien metode Lorenz dan modifikasi PAWPER-XL MAC dengan rerata perawatan 2,00±1,704 dan rerata balans kumulatif 126,99±1483,62, didapatkan nilai p adalah 0,646 dan 0,717 secara berurutan, nilai P10 adalah 84,3% dan 71,1% secara berurutan, nilai P20 adalah 98,8% dan 95,2% secara berurutan, nilai MPE adalah 0,361 dan 0,463 secara berurutan, nilai LOA adalah -14,75 s/d 15,53 dan -18,12 s/d 19,04 secara berurutan. Semua berada dalam rentang yang direkomendasikan. Pengukuran estimasi berat badan aktual metode Lorenz dan modifikasi PAWPER-XL MAC sesuai dengan pengukuran berat badan aktual dengan tempat tidur bertimbangan khusus pada pasien-pasien ICU.
COMPARISON OF 0.7 MG AND 1 MG PROTAMINES ON ACTIVATED CLOTTING TIME AND BLEEDING IN OFF-PUMP CORONARY ARTERY BYPASS PATIENTS: A MULTICENTER STUDY Andika Ahadyat Lukman Wiriaatmaja; Reza Widianto Sudjud; Budiana Rismawan
Multidiciplinary Output Research For Actual and International Issue (MORFAI) Vol. 5 No. 3 (2025): Multidiciplinary Output Research For Actual and International Issue
Publisher : RADJA PUBLIKA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54443/morfai.v5i3.3051

Abstract

Background: Optimal anticoagulation management is crucial for graft patency and minimizing postoperative complications in off-pump coronary artery bypass grafting (OPCAB), a widely performed surgical procedure for coronary artery disease. The role of protamine in neutralizing heparin and its impact on activated clotting time (ACT) and postoperative bleeding remain unclear. This study compared the effects of two protamine doses (0.7 mg and 1 mg per 1 mg of heparin) on ACT and bleeding outcomes in patients who underwent OPCAB. Methods: This multicenter, single-blind, randomized controlled trial was conducted from February to April 2025 and included 50 patients undergoing OPCAB at Dr. Hasan Sadikin General Hospital and Santosa Hospital Central. Patients were randomized into two groups: Group 1 received 0.7 mg of protamine per 1 mg of heparin, and Group 2 received 1 mg of protamine per 1 mg of heparin. The primary outcomes were post-protamine ACT levels and postoperative bleeding at 1, 4, and 12 h. The secondary outcomes included the need for colloid and crystalloid fluid administration. Results: The results showed No significant difference was observed in the ACT between the two groups after protamine administration (p = 0.541). However, postoperative bleeding was significantly lower in the 0.7 mg group than in the 1 mg group at all postoperative time points (p < 0.05). The 1 mg protamine group required significantly more colloid infusion during the procedure (p = 0.001), suggesting greater hemodynamic instability associated with higher protamine doses. Conclusions: A protamine dose of 0.7 mg per 1 mg of heparin was associated with less postoperative bleeding than the standard 1 mg dose, without significant differences in ACT. These findings suggest that lower doses of protamine may be preferable in OPCAB to reduce bleeding risk while maintaining effective heparin neutralization. Further studies are needed to refine the protamine dosing protocols for cardiac surgery.
Management of Intra-Abdominal Infection Patients with Septic Shock in the ICU Ariaty, Geeta Maharani; Rismawan, Budiana
Journal of Society Medicine Vol. 4 No. 9 (2025): September
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i9.238

Abstract

Introduction: Intra-abdominal infections (IAIs) complicated by septic shock pose a critical challenge in intensive care units (ICUs) due to high morbidity and mortality. Effective management requires rapid diagnosis, source control, and optimized antimicrobial therapy. This case report describes the multidisciplinary approach to managing IAI with septic shock, highlighting evidence-based strategies. Case Description: A 59-year-old male presented with septic shock secondary to generalized peritonitis caused by an incarcerated hernia. Initial management included fluid resuscitation with 1,500 mL Ringer’s lactate, norepinephrine, and broad-spectrum antibiotics (meropenem and metronidazole). Emergency laparotomy within 4.5 hours achieved source control by evacuating 300 mL of purulent peritoneal fluid. ICU care involved mechanical ventilation, analgesia (fentanyl, paracetamol), sedation (midazolam, transitioned to dexmedetomidine), and enteral nutrition starting on day three. Multidisciplinary collaboration facilitated hemodynamic stabilization, extubation on day five, and transfer to the high-care unit on day six, with significant clinical improvement. Conclusion: Successful management of IAI with septic shock hinges on timely source control, appropriate antimicrobial therapy, and comprehensive ICU care. The absence of microbiological cultures, a key limitation, underscores the need for improved diagnostic access in resource-limited settings. Adherence to evidence-based protocols and multidisciplinary expertise are critical to improving survival. Future efforts should focus on enhancing diagnostics to optimize therapy and reduce antimicrobial resistance.
Co-Authors Andika Ahadyat Lukman Wiriaatmaja Andri Febriyanto Eka Putra Ardi Zulfariansyah Ardi Zulfariansyah Ariaty, Geeta Maharani Arifin, Ilman Hakim Asep Deden Komara Ezra Oktaliansah Komara, Asep Deden Lusy Octavia Saputri M. Andy Prihartono Ni Wayan Pratiwi Wijaya Oka Endarto Pamugar, Bramantyo Reza Widianto Sudjud Rudi Kurniadi Kadarsah Ruli Herman Sitanggang Saputra, Maulidar Suwarman Suwarman, Suwarman Tia Astriana Wullur, Caroline