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The Indonesian Journal Chest & Critical Emergency Medicine
Published by Perhimpunan Respirologi Indonesia
ISSN : 23554584     EISSN : 26142759     DOI : 10.2614/ijc.v12i3
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The Indonesian Journal Chest & Critical Emergency Medicine eISSN : 2614-2759 /pISSN : 2355-4584 publishes scholarly journals magazine containing original articles, case reports, and review article in subspecialty areas of respirology, critical illness care and medical emergencies. All journals are available for free download online...
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Articles 8 Documents
 1 
Post-Cardiac Injury Syndrome: Do we overlook its presence? A Case of Post-Pericardiotomy Syndrome and Current Update of its Management Strategy. Ian Huang
Indonesia Journal of Chest Critical Emergency Medicine Vol 6 No 2 (2019): Post-Cardiac Injury Syndrome Do We Overlook Its Presence A Case Of Post-Pericardi
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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Abstract Introduction: Postcardiac injury syndrome (PCIS) is the term that encompasses of postpericardiotomy syndrome, postmyocardial infarction syndrome and post-traumatic pericarditis. The patient typically presents with fever, pericardial friction rub, and pericardial effusion with or without pleural effusion. The latency period between surgery and clinical manifestation greatly varied which not seldomly causing a delayed diagnosis of the disease. Case Report: Herein we report a 30-year-old woman with 1-year history of constrictive pericarditis who was scheduled for a pericardiectomy. She had a history a liver tuberculosis of which she was treated with oral antituberculous drug for 18 months. Her physical examination showed an increased jugular venous pressure with a positive Kussmaul’s Sign, cardiomegaly, and minimal bipedal pitting edema, with otherwise normal examination. Her transesophageal echocardiography (TEE) and MSCT cardiac were positive for constrictive pericarditis. The surgery was uneventful with 200 mL of serous pericardial fluid was removed. Ten days after the surgery, the patient complained fever with increased production of the drainage. She was then assessed as post pericardiotomy syndrome and was given high dose steroid. The drainage was gradually decreased and she was discharged after ten days with anti-inflammatory Conclusion:While PCIS is not uncommon, physicians practicing in the field of pulmonary and critical care medicine, and cardiac surgery should be aware not only the presence of this disease, but also to master its prevention and treatment.
Respiratory Syncytial Virus Pneumonia in an Elderly Patient: A Case Report and Clinical Review Eric Daniel Tenda; Almerveldy Azaria Dohong; Sahat Halim; Alfino Syahputra; Muhammad Aziz Arridho
Indonesia Journal of Chest Critical Emergency Medicine Vol 13 No 1 (2026): Respiratory Syncytial VirusPneumoniain an Elderly Patient
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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Background: Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infection and is increasingly recognized as a clinically significant cause of pneumonia in older adults. However, RSV remains underdiagnosed in adult pneumonia because clinical and radiologic features overlap with bacterial pneumonia and other viral infections, and RSV testing is not routinely performed. Case: A 91-year-old man presented with one day of cough, low-grade fever, reduced appetite, generalized weakness, and acute delirium. On admission, he was hemodynamically stable with oxygen saturation 97–98% on room air. Initial laboratory tests showed elevated C-reactive protein (20.7 mg/L), mild lymphopenia, microcytic anemia (hemoglobin 10.0 g/dL), and mild hyponatremia (sodium 132 mEq/L). Chest radiography revealed bilateral pulmonary infiltrates. A multiplex acute respiratory infection PCR panel detected RSV type A, while other respiratory viruses and atypical bacterial pathogens were negative. On day 3 of hospitalization, he developed acute hypoxemia (SpO₂ 86–88% on room air) accompanied by a marked rise in inflammatory markers (CRP peak 148 mg/L; procalcitonin 0.44 ng/mL). He improved with supplemental oxygen, intravenous methylprednisolone, and a macrolide antibiotic, and was discharged in stable condition on day 7. Discussion: This case highlights RSV as an important and often overlooked etiology of community-acquired pneumonia in very old patients, including atypical presentations such as delirium and late clinical deterioration after an initially stable course. Molecular diagnostics (PCR-based panels) can provide timely etiologic confirmation, support infection control measures, and guide antimicrobial stewardship, particularly when bacterial co-infection is uncertain. Conclusion: RSV should be considered in elderly patients with pneumonia, especially during periods of respiratory virus circulation. Early molecular testing may improve diagnostic accuracy and optimize clinical management and prevention strategies in high-risk older adults. Keyword: respiratory syncytial virus; pneumonia; elderly; multiplex PCR; case report
Artificial Intelligence in Bronchoscopy for Pulmonary Disease: A Systematic Review of Randomized Controlled Trials Eric Daniel Tenda; Almerveldy Azaria Dohong; Nadia Iqbal; Aziza Harris; Steffi Cong Andi Nata; Muhammad Aziz Arridho; Alfino Syahputra; Sahat Halim
Indonesia Journal of Chest Critical Emergency Medicine Vol 13 No 1 (2026): Artificial Intelligence in Bronchoscopy for Pulmonary Disease: A Systematic Revi
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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Background: Bronchoscopy is a core diagnostic and therapeutic procedure for pulmonary diseases, yet performance is highly operator dependent, contributing to variability in airway inspection completeness and procedural efficiency. Artificial intelligence (AI) systems have been developed to support real time airway anatomy recognition, navigation, and performance feedback. This systematic review summarizes randomized controlled trial evidence on the impact of AI guided bronchoscopy on procedural performance. Methods: This review followed PRISMA guidance and was registered in PROSPERO. We searched PubMed/MEDLINE, ScienceDirect, and SAGE Journals from database inception to January 2026. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the RoB 2 tool. Given heterogeneity in interventions, populations, and outcome definitions, results were synthesized narratively. Results: From 1,654 records, four randomized controlled trials met inclusion criteria. All studies were conducted in simulation settings and enrolled participants with varying experience (novice to experienced bronchoscopists, including critical care physicians). Overall, AI guided bronchoscopy favored AI supported groups compared with comparators (no AI, written instruction, directed self learning, or expert instruction), showing improvements in key performance domains such as inspection completeness and structured progression, as well as efficiency related metrics including intersegmental time and or total procedure time. Conclusion: Simulation based RCT evidence supports AI as a promising approach to improve standardization and procedural performance in bronchoscopy training. Multicenter patient based randomized trials are warranted to confirm benefits on clinically meaningful outcomes. Keywords: artificial intelligence; bronchoscopy; randomized controlled trial; simulation based training; procedural performance.
DURASI PERLINDUNGAN TPT ISONIAZID 6 BULAN PADA PASIEN HIV SEBAGAI DASAR PEMBERIAN ULANG TPT Gita Euaggelion Tarigan
Indonesia Journal of Chest Critical Emergency Medicine Vol 13 No 1 (2026): DURASI PERLINDUNGAN TPT ISONIAZID 6 BULAN PADA PASIEN HIV SEBAGAI DASAR PEMBERIA
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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Latar Belakang: Tuberkulosis (TB) masih menjadi penyebab utama morbiditas dan mortalitas pada pasien HIV. Isoniazid preventive therapy (IPT) selama 6 bulan terbukti efektif menurunkan risiko TB, namun durasi perlindungan setelah terapi selesai masih belum jelas. Metode: Penulisan ini merupakan evidence-based case report (EBCR). Pencarian literatur dilakukan melalui PubMed, Cochrane, dan Scopus menggunakan kata kunci terkait HIV, IPT 6 bulan, dan durasi perlindungan TB. Artikel yang dipilih meliputi studi kohort, systematic review, dan meta-analysis terkait insidensi TB setelah penyelesaian IPT pada pasien HIV. Telaah kritis dilakukan menggunakan pendekatan Centre for Evidence-Based Medicine (CEBM). Hasil: Tiga studi kohort memenuhi kriteria eligibilitas. Seluruh studi menunjukkan bahwa IPT 6 bulan menurunkan insidensi TB aktif, terutama pada tahun pertama setelah terapi selesai. Efek proteksi dapat bertahan hingga 1–3 tahun, namun cenderung menurun seiring waktu, terutama pada pasien dengan paparan TB berkelanjutan dan status imun yang belum optimal. Penurunan insidensi TB paling jelas ditemukan pada pasien dengan kepatuhan ART yang baik dan penyelesaian IPT yang lengkap. Kesimpulan: IPT 6 bulan efektif menurunkan risiko TB pada pasien HIV, namun perlindungannya tidak bersifat permanen. Pada pasien dengan risiko paparan TB yang tinggi dan berkelanjutan, pemberian ulang TPT dapat dipertimbangkan setelah TB aktif disingkirkan secara adekuat. Kata kunci: HIV, tuberkulosis, IPT, isoniazid, terapi preventif
Korelasi Single Breath Count Test dengan Ketahanan Otot Inspirasi ivena .
Indonesia Journal of Chest Critical Emergency Medicine Vol 13 No 1 (2026): Korelasi Single Breath Count Test dengan Ketahanan Otot Inspirasi
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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Korelasi Single Breath Count Test dengan Ketahanan Otot Inspirasi Ivena1, Melinda Harini1, Peggy1, Dewi Friska2 1Departemen Rehabilitasi Medik, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia 2Departemen Ilmu Kedokteran Komunitas, Fakultas Kedokteran, Universitas Indonesia, Jakarta, Indonesia *email: ivenayuanda93@gmail.com Abstrak Penurunan ketahanan otot inspirasi merupakan hal yang sering dialami oleh lansia dan menyebabkan adanya penurunan kemampuan untuk melakukan aktivitas akibat mudah merasa lelah, sehingga dapat menyebabkan pasien lebih rentan untuk terkena penyakit dan mengalami disabilitas. Penelitian ini dilakukan dengan desain studi potong lintang pada bulan Juli 2024-Juni 2025. Pasien akan dilakukan pengukuran ekspansi thoraks, selanjutnya akan dimasukkan ke dalam rumus MIP, sesuai rumus Moeliono, et al. Ketahanan otot inspirasi akan diuji dengan 10 RM IMT (resistensi di setting 10% dari MIP pasien) dan dinaikkan 2 cmH2O tiap menit. Peneliti akan mengevaluasi hasil dengan membandingkan durasi uji SBCT dengan hasil uji ketahanan otot inspirasi dengan 10 RM IMT. Subjek penelitian yang didominansi oleh jenis kelamin perempuan (70,15%), dengan tingkat pendidikan terbanyak pada SMA, n=29 (43,3%). Komorbid terbanyak berupa hipertensi 22 (32,8%). Ekspansi thoraks didapatkan dengan rerata 3 cm. Nilai MIP pada penelitian ini, didapatkan dengan rerata 68,9 cmH2O (67,9-71,9), dengan rerata pria (n=20) sebesar 70,054 cmH2O dan wanita (n=47) sebesar 68,83 cmH2O. Nilai % MIP memiliki nilai 45% (dengan rerata pada pria 40,61 % dan wanita 46,95%). Didapatkan adanya korelasi positif kuat antara SBCT dengan ketahanan otot inspirasi yang diukur melalui IMT, dengan r = 0,741 pada populasi lansia mandiri di komunitas lansia sehat di Gereja Katolik Hati Kudus Kramat.
ASSOCIATION BETWEEN TIME OF INITIATING EMPIRICAL ANTIBIOTIC AND OUTCOMES IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA I Gede Ketut Sajinadiyasa; Yogi Haditya; I Ketut Agus Somia
Indonesia Journal of Chest Critical Emergency Medicine Vol 13 No 1 (2026): ASSOCIATION BETWEEN TIME OF INITIATING EMPIRICAL ANTIBIOTIC AND OUTCOMES IN PATI
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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ABSTRACT Background: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality worldwide, with a significant burden in Indonesia. Early initiation of empirical antibiotics is considered crucial in improving outcomes, yet evidence has been inconsistent and local data are lacking. Objective of this study is to evaluate the association between the timing of empirical antibiotic initiation and clinical outcomes, specifically mortality and length of hospital stay, among CAP patients at RS Ngoerah, Denpasar. Methods: A prospective observational study was conducted on adult inpatients with CAP between January and June 2024. Patients were stratified into two groups based on antibiotic initiation time: ≤4 hours and >4 hours after admission. Data were analyzed using Chi-square, Logistic regression, and Linier regression to adjust for confounders, including age, sex, comorbidities, and disease severity. Results: A total of 235 patients were enrolled. Early antibiotic initiation (≤4 hours) significantly reduced 30-day mortality compared to delayed administration (>4 hours) (adjusted OR 4,97; 95% CI 1,50–16,47; p<0.05). No statistically significant difference was observed in the length of hospital stay (median 5 vs 5 days; p=0.95). Length of stay was more influenced by comorbidities, and antibiotic used. Conclusion: Empirical antibiotic initiation later than 4 hours is associated with increase mortality in CAP patients, although it does not significantly affect length of hospital stay. These findings highlight the importance of timely antibiotic administration to improve clinical outcomes in CAP. Keywords: community-acquired pneumonia, antibiotics, timing, mortality, hospital stay
Uji Diagnostik Lipoarabinomannan Urin untuk Deteksi Mycobacterium tuberculosis pada Pasien Dengan dan Tanpa Infeksi HIV Andriana Kirana Puspa; Dean Handimulya
Indonesia Journal of Chest Critical Emergency Medicine Vol 12 No 2 (2025): Uji Diagnostik Lipoarabinomannan Urin untuk Deteksi Mycobacterium tuberculosis p
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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Background Most of the tuberculosis (TB) diagnostic tests rely on sputum samples, which are often difficult to obtain in children, patients with extrapulmonary TB and people living with Human Immunodeficiency Virus (PLHIV). Lipoarabinomanan (LAM), a major component of the Mycobacterium tuberculosis (Mtb) cell wall, function as a virulence factor and can enter the systemic circulation during infection. Due to its relatively small molecular size, LAM is filtered by the kidneys and can detected in urine. Detection of urinary LAM antigen offers a non invasive and rapid diagnostic approach that can be performed as appoint of care test (POCT), providing a promising tool for TB diagnosis, especially in individuals with difficulty producing sputum or those who are immunocompromised, such as PLHIV. Method A cross-sectional study was conducted at dr. Cipto Mangunkusumo National General Hospital involving 96 subjects with suspected tuberculosis (TB), with or without Human deficiency Virus (HIV) infection. Urine samples were tested using Abbott Determineä TB LAM Ag, a lateral flow immunoassay for detecting lipoarabinomannan antigen. Diagnostic performance was compared with a composite reference standard, define as appositive result in at least one of the following tests: real time polymerase chain reaction (RT-PCR), acid-fast bacilli smear, or acid-fast bacilli culture. Numeric data were tested for normality using Kolmogorov-Smirnov test and presented as median (range), while categorical data were expressed as absolute frequency (n) and percentage (%). Diagnostic performance was assessed in terms of sensitivity, specifity, predictive values, and accuracy. Result Among 96 subjects, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the urinary LAM test compared with bacteriological TB results were 51%, 68%, 46%, and 73%, respectively. In 33 participants with HIV infection, the sensitivity, specificity, PPV, and NPV were 54%, 59%, 40%, and 72%, respectively. In 63 participants without HIV, the sensitivity and PPV were both 50%, while specificity and NPV were 73%. The urinary LAM test demonstrated moderate diagnostic performance, with slightly higher sensitivity among patients with HIV infection compared to those without. CONCLUSION: The urinary LAM test is a rapid and simple diagnostic tool for tuberculosis. It demonstrated moderate diagnostic performance, with higher sensitivity among patients with HIV infection compared to those without, suggesting greater utility as an adjunct diagnostic test in this population. Keywords: Human Immunodeficiency Virus, Lipoarabinomannan, Tuberculosis, Point of care testing, Urine
Effect of Pulmonary-Specific Enteral Nutrition on Neutrophil-to-Lymphocyte Ratio and Blood Lactate Levels in Mechanically Ventilated Pneumonia Patients: A Double-Blind Randomized Controlled Trial Achmad Mudassir Muchlis
Indonesia Journal of Chest Critical Emergency Medicine Vol 13 No 1 (2026): Effect of Pulmonary-Specific Enteral Nutrition on Neutrophil-to-Lymphocyte Ratio
Publisher : PERPARI (Perhimpunan Respirologi Indonesia)

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Background: Pneumonia remains a major cause of morbidity and mortality, particularly among critically ill patients requiring mechanical ventilation. Systemic inflammation and metabolic dysfunction may be reflected by biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and blood lactate levels. Pulmonary-specific enteral nutrition has been proposed to improve metabolic responses in these patients. This study aimed to evaluate its effect on NLR and blood lactate levels in mechanically ventilated pneumonia patients. Methods: A double-blind randomized controlled trial was conducted in the intensive care and high care units of a tertiary referral hospital in Jakarta, Indonesia. Adult mechanically ventilated pneumonia patients were randomized to receive either pulmonary-specific enteral nutrition or standard enteral nutrition. NLR and blood lactate levels were measured on days 1, 3, and 5. Within-group comparisons were analyzed using the Friedman test, while between-group comparisons were assessed using the Mann–Whitney U test. Results: Of 56 randomized patients, 46 completed the study and were included in the final analysis (24 intervention vs. 22 control). No significant differences in NLR changes were observed between groups during the observation period. However, blood lactate dynamics differed significantly between groups at the day 3–5 interval (p = 0.017) and cumulatively from day 1 to day 5 (p = 0.037), with the intervention group demonstrating a more stable decline in lactate levels. Conclusion: Pulmonary-specific enteral nutrition was associated with improved lactate dynamics, suggesting better metabolic stability in mechanically ventilated pneumonia patients, although no significant effect on NLR was observed. Keywords: Pneumonia; Enteral Nutrition; Mechanical Ventilation; Neutrophil-to-Lymphocyte Ratio; Lactate

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All Issue Vol 13 No 1 (2026): DURASI PERLINDUNGAN TPT ISONIAZID 6 BULAN PADA PASIEN HIV SEBAGAI DASAR PEMBERIA Vol 13 No 1 (2026): ASSOCIATION BETWEEN TIME OF INITIATING EMPIRICAL ANTIBIOTIC AND OUTCOMES IN PATI Vol 13 No 1 (2026): Artificial Intelligence in Bronchoscopy for Pulmonary Disease: A Systematic Revi Vol 13 No 1 (2026): Effect of Pulmonary-Specific Enteral Nutrition on Neutrophil-to-Lymphocyte Ratio Vol 13 No 1 (2026): Korelasi Single Breath Count Test dengan Ketahanan Otot Inspirasi Vol 13 No 1 (2026): Respiratory Syncytial VirusPneumoniain an Elderly Patient Vol 12 No 2 (2025): Uji Diagnostik Lipoarabinomannan Urin untuk Deteksi Mycobacterium tuberculosis p Vol 6 No 2 (2019): Post-Cardiac Injury Syndrome Do We Overlook Its Presence A Case Of Post-Pericardi