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Diameter dan Indeks Inferior Vena Cava (IVC) Berkorelasi dengan Central Venous Pressure (CVP) pada Pasien Kritis yang Menggunakan Ventilasi Mekanik di Intensive Care Unit (ICU) Buyung Hartiyo Laksono; Arie Zainul Fatoni; Vilda Prasastri Yuwono; Aswoco Andyk Asmoro
JAI (Jurnal Anestesiologi Indonesia) Vol 13, No 2 (2021): 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.v13i2.33829

Latar belakang: Pengukuran central venous pressure (CVP) merupakan salah satu metode guiding deresusitasi pada pasien dengan kasus tertentu. Kenaikan nilai CVP 1 mmHg dikaitkan dengan peningkatan angka kejadian acute kidney injury (AKI). Namun sebagai sebuah metode yang invasif, pemasangan CVP memiliki risiko yang perlu diperhatikan. Di sisilain, pengukuran diameter dan indeks IVC yang bermuara di atrium kanan dengan menggunakan ultrasonografi (USG) non-invasif dinilai mampu untuk memprediksi nilai CVP pada pasien. Namun beberapa penelitian hubungan antara CVP dengan diameter dan indeks IVC memberikan hasil yang kontroversial.Tujuan: Penelitian untuk mengetahui hubungan antara nilai CVP dengan diameter dan indeks IVC.Metode: Penelitian ini menggunakan metode cross-sectional pada 30 pasien yang dilakukan ventilasi mekanik dan pemasangan CVC di unit perawatan intensif. Parameter CVP, diameter minimum dan maksimum inferior vein cava (IVC mak, IVC min), distensibillity index (DI-index), dan aortacaval index (Cava/Ao index) diukur. Data dianalisis menggunakan uji korelasi pada SPPS 18.0 (p<0.05).Hasil: Didapatkan korelasi signifikan antara CVP dan semua variabel yang diuji (IVC mak, IVC min, DI-index, dan Cava/Ao index) (p<0.05), dengan korelasi terkuat antara CVP dan IVC min (R= 0,908). Korelasi bersifat positif, kecuali antara DI-index dan CVP.Kesimpulan: Parameter IVC min, IVC mak, Cava/Ao- index, dan DI-index signifikan berkorelasi kuat dengan CVP. Korelasi terjadi bersifat positif, kecuali antara DI-index dan CVP.

Ketamine Improves Sepsis-induced Immunosuppression by Attenuating Intracellular Calcium Elevation in Rat Peripheral Mononuclear Cells Puspita Abidatul Qodariyah; Afiyf Kaysa Waafi; Christian Julio Suhardi; Karina Survival Rofiq; Aswoco Andyk Asmoro; Edi Widjajanto
Research Journal of Life Science Vol 5, No 1 (2018)
Publisher : Lembaga Penelitian dan Pengabdian kepada Masyarakat, Universitas Brawijaya

Immune response in sepsis divided into two phases, hyper-inflammation (cytokine storm) and hypo-inflammation (immunosuppression). The mechanism of immunosuppression appears to involve apoptosis of immune cells, particularly mononuclear cells and it predisposes to secondary infection that is believed as the predominant driving force for mortality. We aimed to determine the effect of ketamine on mononuclear cells count related to intracellular calcium contained within these cells during the immunosuppression phase of sepsis.This in vivo study was performed in Rattus Novergicus with Fecal Induced Perionitis (FIP) procedure to induce polymicrobial sepsis. Rats were treated with each respective dose of ketamine (2.5, 5, and 10 mg/kg) 1 hour after sepsis induction. Murine Sepsis Score was measured at 1 and 24 hours post-FIP. After 24 hours, animals were sacrificed, and the percentage of intracellular calcium inside CD4, and CD8 T cells, B cells and monocytes, along with these cells counts were determined with flowcytometry. There are significant elevation of intracellular calcium in CD4 T-cells, B-cells and monocytes after FIP-induction and ketamine treatment suppressed this FIP-induced elevation. Measurement of mononuclear cells count showed a relevant result, in which FIP induced mononuclear cells massive loss and ketamine could inhibit the loss. MSS data showed ketamine 5 mg/kg could improve 24 hours MSS with 100% survivability.These findings suggest that ketamine have an inhibitory effect in mononuclear-cells apoptosis mechanism through attenuating intracellular calcium elevation in polymicrobial sepsis. These inhibitory effects of ketamine might correlate with a better survival and clinical outcome.

Ketamin Sebagai Inhibitor Kalsium Intraseluler pada Human Umbilical Vein Endothelial Cell (HUVEC) Model Sepsis Rudy Vitraludyono; Aswoco Andyk Asmoro; Edi Widjajanto
Journal of Anaesthesia and Pain Vol 1, No 1 (2020): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2020.001.01.02

Latar belakang: Sepsis berat dan syok sepsis memiliki angka kematian yang tinggi. Agen anestesi yang sering digunakan untuk pasien sepsis adalah ketamin. Perubahan kadar kalsium dalam sel berkontribusi dalam peningkatan respon imun dan kerusakan jaringan. Penelitian ini bertujuan untuk membandingkan efek ketamin terhadap ekspresi kalsium intraseluler Human Umbilical Vein Endotel Cell pada jam ke-3 pasca paparan LPS dibandingkan dengan HUVEC model sepsis.Metode: Sebanyak 30 sumuran culture HUVEC diberi perlakuan sesuai kelompok perlakuan. Kelompok P1 (HUVEC + LPS), kelompok P2 / Model sepsis (HUVEC + LPS + Monosit), kelompok P3 (HUVEC + LPS + Ketamin 50 µmol/L) dan kelompok P4/ Model sepsis + Ketamin (HUVEC + LPS + Monosit + Ketamin 50 µmol/L). Ekspresi kalsium intraseluler dianalisis menggunakan metode imunofluoresens 3 jam setelah pemberian Ketamin. Data hasil penelitian diuji statistic menggunakan uji T dua sampel bebas menggunakan software SPSS 18.0.Hasil: Sepsis menyebabkan peningkatan konsentrasi kalsium intraseluler yang signifikan dibandingkan dengan kontrol (p<0,05). Ketamin 50 µmol/L secara signifikan mampu menurunkan ekspresi kalsium intraseluler pada model sepsis secara signifikan. Selain itu, ketamin juga menujukkan aktivitas penghambatan produksi kalsium intraseluler pada HUVEC yang hanya diinduksi LPS.Kesimpulan: Pemberian Ketamin 50 µmol/L dapat menurunkan ekspresi kalsium intraseluler pada HUVEC yang dipapar LPS dan HUVEC model sepsis. Ketamin dapat digunakan sebagai imunoterapi sepsis dengan memodulasi konsentrasi kalsium intraseluler.

Pneumomediastinum and Spontaneous Subcutaneous Emphysema in COVID-19 Patients Using High-Flow Nasal Cannula (HFNC) Suhadayanti, Rizki; Fatoni, Arie Zainul; Jaya, Wiwi; Asmoro, Aswoco Andyk
Jurnal Respirologi Indonesia Vol 44, No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.448

Background: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema are rare complications that occur without mechanical ventilation, namely 0.81% of all COVID-19 patients. During the COVID-19 pandemic, high-flow nasal cannulas (HFNC) were used to support respiratory failure in critically ill patients. However, there have been no clinical trials explaining its safety and effectiveness. Hypoxemic normocapnic respiratory failure is an indicator of HFNC use. This study reports a case of associated spontaneous subcutaneous pneumomediastinum and emphysema in a COVID-19 patient using HFNC.Case: A 30-year-old male patient came to the hospital with a chief complaint of increasingly severe shortness of breath and confirmed COVID-19. Physical examination revealed a good airway, spontaneous breathing with a frequency of 28 times/minute; SpO2 of 97% with HFNC Flow 60 and FiO2 60%; blood pressure of 102/69 mmHg; and heart rate of 65 beats per minute. On the second day of treatment in the ICU, the patient did not experience desaturation or hypotension. Patent airway, spontaneous breathing, and oxygenation initiated using NRM 10lpm with a target SpO2 of 97%, RR at 30-32x/minute. On the fifth day, desaturation and hypotension were no longer observed.Discussion: Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel detects SARS-CoV-2 in respiratory samples. Chest CT scans show viral pneumonia. Subcutaneous emphysema (SE) and pneumomediastinum cause breathing issues. Severe COVID-19 is treated with antivirals, vitamins, and oxygen therapy. Pneumomediastinum or subcutaneous emphysema may occur due to prolonged non-invasive ventilation but is generally self-limited.Conclusion: Clinical improvement was found in COVID-19 patients with pneumomediastinum and spontaneous subcutaneous emphysema using HFNC.

Comparison of Intermittent Epidural Bolus and Continuous Epidural Infusion for Postoperative Pain Management in Abdominal Surgery Patients Siswagama, Taufiq Agus; Asmoro, Aswoco Andyk; Subagyo, Houdini Pradanawan; Laksono, Buyung Hartiyo
Journal of Anaesthesia and Pain Vol 5, No 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.02

Background: Abdominal surgery often leads to high postoperative pain scores, which are commonly managed using epidural analgesia through either continuous infusion or intermittent bolus administration. This study aimed to compare the effectiveness of intermittent epidural bolus and continuous epidural infusion in managing postoperative pain among patients who underwent abdominal surgery.Methods: This cross-sectional study included 90 patients who underwent abdominal surgery and were randomly assigned to two groups. Group one received intermittent epidural bolus analgesia with ropivacaine 0.1875% and fentanyl 50 µg, administered as 10 cm³ every 8 hours (n=45). Group two received continuous epidural infusion analgesia with ropivacaine 0.1875% and fentanyl 100 µg, in a total volume of 50 cm³ at a rate of 3 cm³/hour (n=45). Pain levels were assessed using the numerical rating scale (NRS) at rest and during movement, measured every 12 hours for 84 hours. Statistical analysis was conducted using the independent t-test with a significance level of α=0.05 and a 95% confidence interval.Result: At 24 hours postoperatively, the NRS at rest was significantly lower in the continuous infusion epidural (0.15 ± 0.36) compared to the intermittent bolus (0.91 ± 0.35) (p=0.000), and this trend persisted at subsequent time points (36, 48, 60, 72, and 80 hours postoperatively). For movement, the NRS at 36 hours was also lower in the continuous infusion epidural (1.00 ± 0.00) compared to the intermittent bolus (1.29 ± 0.45) (p=0.000), with similar differences observed at other time points.Conclusion: Continuous epidural infusion provides superior analgesia to intermittent epidural bolus administration in abdominal surgery patients. This method is associated with faster and sustained reductions in pain intensity at rest and during movement.

Comparison of Intermittent Epidural Bolus and Continuous Epidural Infusion for Postoperative Pain Management in Abdominal Surgery Patients Siswagama, Taufiq Agus; Asmoro, Aswoco Andyk; Subagyo, Houdini Pradanawan; Laksono, Buyung Hartiyo
Journal of Anaesthesia and Pain Vol. 5 No. 3 (2024): September
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.03.02

Background: Abdominal surgery often leads to high postoperative pain scores, which are commonly managed using epidural analgesia through either continuous infusion or intermittent bolus administration. This study aimed to compare the effectiveness of intermittent epidural bolus and continuous epidural infusion in managing postoperative pain among patients who underwent abdominal surgery.Methods: This cross-sectional study included 90 patients who underwent abdominal surgery and were randomly assigned to two groups. Group one received intermittent epidural bolus analgesia with ropivacaine 0.1875% and fentanyl 50 Âµg, administered as 10 cmÂ³ every 8 hours (n=45). Group two received continuous epidural infusion analgesia with ropivacaine 0.1875% and fentanyl 100 Âµg, in a total volume of 50 cmÂ³ at a rate of 3 cmÂ³/hour (n=45). Pain levels were assessed using the numerical rating scale (NRS) at rest and during movement, measured every 12 hours for 84 hours. Statistical analysis was conducted using the independent t-test with a significance level of Î±=0.05 and a 95% confidence interval.Result: At 24 hours postoperatively, the NRS at rest was significantly lower in the continuous infusion epidural (0.15 Â± 0.36) compared to the intermittent bolus (0.91 Â± 0.35) (p=0.000), and this trend persisted at subsequent time points (36, 48, 60, 72, and 80 hours postoperatively). For movement, the NRS at 36 hours was also lower in the continuous infusion epidural (1.00 Â± 0.00) compared to the intermittent bolus (1.29 Â± 0.45) (p=0.000), with similar differences observed at other time points.Conclusion: Continuous epidural infusion provides superior analgesia to intermittent epidural bolus administration in abdominal surgery patients. This method is associated with faster and sustained reductions in pain intensity at rest and during movement.

Pneumomediastinum and Spontaneous Subcutaneous Emphysema in COVID-19 Patients Using High-Flow Nasal Cannula (HFNC) Suhadayanti, Rizki; Fatoni, Arie Zainul; Jaya, Wiwi; Asmoro, Aswoco Andyk
Jurnal Respirologi Indonesia Vol 44 No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.448

Background: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema are rare complications that occur without mechanical ventilation, namely 0.81% of all COVID-19 patients. During the COVID-19 pandemic, high-flow nasal cannulas (HFNC) were used to support respiratory failure in critically ill patients. However, there have been no clinical trials explaining its safety and effectiveness. Hypoxemic normocapnic respiratory failure is an indicator of HFNC use. This study reports a case of associated spontaneous subcutaneous pneumomediastinum and emphysema in a COVID-19 patient using HFNC.Case: A 30-year-old male patient came to the hospital with a chief complaint of increasingly severe shortness of breath and confirmed COVID-19. Physical examination revealed a good airway, spontaneous breathing with a frequency of 28 times/minute; SpO2 of 97% with HFNC Flow 60 and FiO2 60%; blood pressure of 102/69 mmHg; and heart rate of 65 beats per minute. On the second day of treatment in the ICU, the patient did not experience desaturation or hypotension. Patent airway, spontaneous breathing, and oxygenation initiated using NRM 10lpm with a target SpO2 of 97%, RR at 30-32x/minute. On the fifth day, desaturation and hypotension were no longer observed.Discussion: Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel detects SARS-CoV-2 in respiratory samples. Chest CT scans show viral pneumonia. Subcutaneous emphysema (SE) and pneumomediastinum cause breathing issues. Severe COVID-19 is treated with antivirals, vitamins, and oxygen therapy. Pneumomediastinum or subcutaneous emphysema may occur due to prolonged non-invasive ventilation but is generally self-limited.Conclusion: Clinical improvement was found in COVID-19 patients with pneumomediastinum and spontaneous subcutaneous emphysema using HFNC.

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