Analisis Syndecan-1 Laktat dan Profil Lipid Sebagai Faktor Risiko Keparahan dan Mortalitas Sepsis

Pada sepsis, endothelial glycocalyx (EG), dapat rusak dan luruh melepaskan syndecan-1 ke dalam plasma. Kerusakan EG akan mengganggu mikrosirkulasi, menimbulkan hipoperfusi jaringan, dan meningkatkan kadar laktat. Gangguan profil lipid pada sepsis terjadi karena gangguan metabolisme dan kerusakan langsung hepatosit akibat meluruhnya EG. Penelitian ini bermaksud menganalisis syndecan-1, laktat, dan profil lipid sebagai faktor risiko keparahan dan mortalitas pada pasien sepsis. Penelitian ini adalah penelitian analitik observasional pada 39 pasien dewasa yang memenuhi kritera sepsis-3. Keparahan sepsis diklasifikasikan menjadi sepsis dan syok septik dan ditentukan dalam 6 jam setelah time zero berdasarkan penggunaan vasopresor, kecukupan resusitasi cairan, dan nilai laktat ulangan. Kematian 7 hari dihitung sejak time zero sepsis. Syndecan-1, laktat, dan profil lipid diambil dalam jam pertama setelah time zero dianalisis sebagai faktor risiko keparahan dan mortalitas 7 hari. Analisis data dilakukan dengan uji logistik regresi bivariat dan multivariat. Pada penelitian ini didapatkan 20 pasien dengan sepsis, 19 pasien dengan syok septik. Berdasar atas mortalitas 7 hari, 10 pasien meninggal dan 29 pasien bertahan hidup. Laktat dan syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan variabel yang lebih superior dibanding dengan syndecan-1 sebagai prediktor keparahan sepsis. Laktat merupakan prediktor untuk mortalitas 7 hari pada pasien sepsis. Simpulan penelitian ini adalah laktat dan syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan prediktor kematian 7 hari pada sepsis. Syndecan-1 Lactate and Lipid Profiles as Risk Factors for Severity and Mortality in SepsisIn sepsis, endothelial glycocalyx (EG) may experience damages and decay, releasing syndecan-1 into plasma. EG damages will disrupt microcirculation, causing tissue hypoperfusion and increasing lactate levels. Disorders of the lipid profile in sepsis occur due to metabolic disorders and direct hepatocyte damages due to EG shedding. This study intended to analyze the Syndecan-1, lactate, and lipid profiles as risk factors for severity and mortality in septic patients. This was an observational analytic study on 39 adult patients who met the criteria for sepsis-3. Sepsis severity was classified into sepsis and septic shock and was determined within 6 hours after time zero based on the vasopressor use, adequacy of fluid resuscitation, and repeat lactate values. The 7-day mortality was counted from time zero sepsis. Syndecan-1, Lactate, and Lipid Profiles were assessed within the first hour after time zero and analyzed as risk factors for severity and 7-day mortality. Data analysis was performed using bivariate and multivariate logistic regression tests. In this study, there were 20 patients with sepsis, 19 patients with septic shock. Based on the 7-day mortality, 10 patients died and 29 patients survived. Lactate and Syndecan-1 are predictors of severity in sepsis. Lactate is superior than Syndecan-1 as a predictor of sepsis severity and is a predictor of 7-day mortality in septic patients. Nonetheless, both lactate and Syndecan-1 are predictors of severity in sepsis.Pada sepsis, endothelial glycocalyx (EG), akan rusak dan luruh, melepaskan syndecan-1 ke dalam plasma. Kerusakan EG akan mengganggu mikrosirkulasi, menimbulkan hipoperfusi jaringan dan meningkatkan kadar laktat. Gangguan profil lipid pada sepsis terjadi karena gangguan metabolism dan kerusakan langsung hepatosit akibat meluruhnya EG. Tujuan: Menganalisis Syndecan-1, Laktat dan Profil Lipid sebagai faktor risiko keparahan dan mortalitas pada pasien sepsis. Metode: Penelitian ini adalah penelitian analitik observasional pada 39 pasien dewasa yang memenuhi kritera sepsis-3. Keparahan sepsis diklasifikasikan menjadi sepsis dan syok septik dan ditentukan dalam 6 jam setelah time zero berdasarkan penggunaan vasopressor, kecukupan resusitasi cairan dan nilai laktat ulangan. Kematian 7 hari dihitung sejak time zero sepsis. Syndecan-1, Laktat dan Profil Lipid diambil dalam jam pertama setelah time zero dianalisis sebagai faktor risiko keparahan dan mortalitas 7 hari. Digunakan analisis normalitas data, uji logistik regresi bivariat dan multivariat. Hasil: Pada penelitian ini didapatkan 20 pasien dengan sepsis, 19 pasien dengan syok septik. Berdasarkan mortalitas 7 hari, 10 pasien meninggal dan 29 pasien bertahan hidup. Laktat dan Syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat (RR 3,597 CI 95% 1,373 – 9,421 p 0,009) merupakan variabel yang lebih superior dibandingkan Syndecan-1 (RR 1,009 CI 95% 1,002 – 1,016 p 0,018) sebagai prediktor keparahan sepsis. Laktat (RR 2,369 CI 95% 1,021 – 5,495 p 0,045) merupakan prediktor untuk mortalitas 7 hari pada pasien sepsis. Simpulan: Laktat dan Syndecan-1 merupakan prediktor keparahan pada sepsis. Laktat merupakan prediktor kematian 7 hari pada sepsis

Analisis Faktor Risiko Oxygenation Index, Oxygen Saturation Index, dan Rasio Pao2/Fio2 sebagai Prediktor Mortalitas Pasien Pneumonia COVID-19 dengan ARDS di Ruang Perawatan Intensif Isolasi Khusus RSUD Dr Soetomo

Pada kasus berat, pneumonia COVID-19 terjadi perburukan secara cepat dan progresif yang menyebabkan ARDS. Pengukuran parameter oksigenasi seperti oxygenation index (OI) dan oxygen saturation index (OSI) pada beberapa penelitian menunjukkan superioritas dibanding dengan rasio PaO2/FiO2 dalam menilai status oksigenasi dan derajat keparahan ARDS. Penelitian ini bertujuan melakukan analisis faktor risiko OI, OSI, dan Rasio PaO2/FiO2 terhadap mortalitas pasien pneumonia COVID-19 dengan ARDS. Penelitian ini adalah penelitian analitik observaional dengan desain cohort-prospective terhadap pasien dewasa pneumonia COVID-19 dengan ARDS berdasar atas kriteria Berlin. Data perhitungan OI, OSI, dan rasio PaO2/FiO2 diambil pada 30 menit pertama pascapemasangan ventilator mekanik. Analisis regresi logistik digunakan untuk menganalisis faktor risiko OI, OSI, dan rasio PaO2/FiO2 terhadap mortalitas 28 hari pasien pneumonia COVID-19 dengan ARDS. Hasil penelitian didapatkan pada 77 pasien yang memenuhi kriteria inklusi dan tidak termasuk eksklusi, hanya variabel OI yang terbukti signifikan sebagai prediktor independen mortalitas dengan nilai p 0,043, sementara OSI dan rasio PaO2/FiO2 tidak signifikan. Dari ketiga variabel, OI mempunyai AUC tertinggi, yakni 0,935 dibanding dengan variabel OSI dan rasio PaO2/FiO2. Simpulan, OI terbukti sebagai prediktor independen mortalitas pada pasien pneumonia COVID-19 dengan ARDS.Oxygen Index, Oxygenation Saturation Index, and Pao2/Fio2 Ratio as Predictors of Mortality in Pneumonia Covid-19 with ARDS Patients Treated in Intensive Isolated Care Unit In severe COVID-19 cases, worsening of pneumonia occurs rapidly and leads to ARDS. Oxygenation parameters such as oxygenation index (OI) and oxygen saturation index (OSI) has been shown to be superior when compared to the PaO2/FiO2 ratio in assessing the oxygenation status and ARDS severity in some studies. Currently, there are limited studies that explore the prognostic values of these parameters in pneumonia COVID-19 with ARDS. This study aimed to analyze the OI, OSI, and PaO2/FiO2 Ratio as predictors of mortality in pneumonia COVID-19 with ARDS in patients treated in the intensive isolated care room. This was an observational analytic study conducted at dr. Soetomo Hospital, Indonesia, on adult patients who met the criteria for pneumonia COVID-19 with ARDS based on Berlin criteria. Data on OI, OSI, and PaO2/FiO2 were collected based on the results of measurements 30 minutes post-intubation and mechanical ventilation in these patients. Logistic regression analysis was used to analyze the OI, OSI, and PaO2/FiO2 as risk factors for 28 days mortality of pneumonia COVID-19 patients with ARDS. In a total of 77 patients eligible for the analyses, it was observed that OI was independently associated with hospital mortality (p 0.043) while OSI and PaO2/FiO2 ratio were not statistically significant. From these three variables, the AUC for mortality prediction was the greatest for OI (AUC 0.935, p<0.05). In conclusion, OI is the only one that is proven to be the independent predictor mortality with the highest sensitivity and specificity compared to the OSI and PaO2/FiO2 ratio for patients with pneumonia covid-19 with ARDS.Pada kasus berat, pneumonia COVID-19 terjadi perburukan secara cepat dan progresif yang  menyebabkan ARDS. Pengukuran parameter oksigenasi seperti oxygenation index (OI) dan oxygen saturation index (OSI) pada beberapa penelitian menunjukkan superioritas dibanding dengan rasio PaO2/FiO2 dalam menilai status oksigenasi dan derajat keparahan ARDS. Penelitian ini bertujuan melakukan analisis faktor risiko OI, OSI, dan Rasio PaO2/FiO2 terhadap mortalitas pasien pneumonia COVID-19 dengan ARDS. Penelitian ini adalah penelitian analitik observaional dengan desain cohort-prospective terhadap pasien dewasa pneumonia COVID-19 dengan ARDS berdasar atas kriteria Berlin. Data perhitungan OI, OSI, dan rasio PaO2/FiO2 diambil pada 30 menit pertama pascapemasangan ventilator mekanik. Analisis regresi logistik digunakan untuk menganalisis faktor risiko OI, OSI, dan rasio PaO2/FiO2 terhadap mortalitas 28 hari pasien pneumonia COVID-19 dengan ARDS. Hasil penelitian didapatkan pada 77 pasien yang memenuhi kriteria inklusi dan tidak termasuk eksklusi, hanya variabel OI yang terbukti signifikan sebagai prediktor independen mortalitas dengan nilai p 0,043, sementara OSI dan rasio PaO2/FiO2 tidak signifikan.  Dari ketiga variabel, OI mempunyai AUC tertinggi, yakni 0,935 dibanding dengan variabel OSI dan rasio PaO2/FiO2. Simpulan, OI terbukti sebagai prediktor independen mortalitas pada pasien pneumonia COVID-19 dengan ARDS

Comparison of central vein pressure between distal, medial, and proximal lumens with water manometer method

ABSTRACT Catheter Vein Pressure in ward-cared patients is rarely measured and considered invalid. The two catheter vein pressure postulates contradict, making confusion among health workers. Dr Russo said the distal-medial-proximal Catheter Vein Pressure has no difference but were denied by Susan S. Scott. Proof of postulate is needed as a solution to inward care. Therefore, this study aimed to compare the central vein pressure between distal, medial, and proximal lumens with the water manometer method. Forty-nine samples retrospective study were taken from the distal - medial - proximal Catheter Vein Pressure of the "zero" until fifth days. The differences are analyzed with Statistical Paired t Test with p-Value < 0.05 from SPSS ver. 26 to prove the right postulate. 49 samples were concluded to represent of population. Catheter Vein Pressure from day "zero" becomes zero difference, the fifth day 91.8% are no difference while the rest have difference of 0.2 - 1.0 cm H2O and the conclusion are no significant difference with 95% CI. The correlation scale of 0.998 and 0.999 proves that the three lumens tend to produce no differences. In conclusion, the distal - medial - proximal Catheter Vein Pressure values in this study have no significant differences and consistent from "zero" until fifth days. This is formulated as P distal = P medial = P proximal (cm H2O).Keywords      : Central Vein Pressure, Pressure, distal - medial - proximal, no differences, ward patient.Correspondence    : [email protected]

BACTERIAL AND SENSITIVITY PATTERN OF PATHOGENS CAUSING VENTILATOR-ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

Highlight: 1. Antimicrobial resistance bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. 2. Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to the non-VAP group. 3. The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. Cefoperazone-sulbactam, meropenem and amikacin were more than 70% sensitive against these bacteria. Abstract: Background: Ventilator-Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit (ICU). Antimicrobial resistant bacteria isolated from VAP patients are often associated with high mortality and length of hospital stay. Objective: This study aimed to analyze the pattern and sensitivity among pathogens that caused VAP in ICU. Materials and Methods: The study was conducted retrospectively by extracting the data of bacterial isolates from sputum specimens in the Laboratory of Clinical Microbiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia and confirming the clinical data on patients suffering from VAP in ICU ward. The study started from January until December 2017. Results: The total 148 pathogens were isolated, 18 of them were diagnosed as VAP, and 130 were not VAP. The most predominant isolates in the VAP group were Acinetobacter baumannii as many as 38 (9%) followed by Pseudomonas aeruginosa 22 (2%), E. coli 16 (7%), and Klebsiella pneumoniae 11 (1%). The pathogens showed a sensitivity rate above 70% to cefoperazone-sulbactam (SCF), meropenem (MEM) and amikacin (AK). Mortality in VAP patients was 33.3% and the VAP group had a longer hospital stay compared to non-VAP group. Conclusion: The three most predominant bacteria that were found were A. baumannii, P. aeruginosa, K. pneumoniae. The pathogens had sensitivity rate above 70% to cefoperazone-sulbactam, meropenem, and amikacin

Retention of basic life support in medical students of Airlangga University

Background: Cardiac arrest is one of the leading cause of death in the world with steadily increasing number over the years. Basic life support has been proven to lower the risks of tissue damage and further complication. Several study shows that BLS skill are lacking in some doctors and nurses. Objective: Therefore, the purpose of this study is knowing the retention of basic life support in medical student of Airlangga University. Methods: This descriptive study used cross sectional design. Subjects were students at faculty of medicine in Airlangga University who trained one year ago and completed their study of Basic Life Support. Fifty two subject were asked to practice their BLS techniques then scored based on modified American Hearth Assosiation (AHA)’s Basic life support skill checklist. Results: Based on the data, the percentage of students who did the retest correctly: response checked by shouting 92.31% students, response checked by tapping 69.23% students, call for help 44.23% students, airway checked 48.08% students, breathing checked 46.15% students, correct hand placement 100% students, compression rate 78.85% students, compression ratio 75% students, position 94.23% students, and compression depth 78.85% students.  Conclusion: One year post training and test, 14 from 52 students could complete all the steps in basic life support skill. Less than a half of the students successfully done 3 out of 10 points that were being tested. Meanwhile, many aspects in circulation point show higher results all above 75%

Renal angina index in pediatric septic patients as a predictor of acute kidney injuryin remote area

Abstract Background: One of the most common sepsis comorbidities is severe acute kidney injury (AKI), which occurs in about 20% of pediatric patients with severe sepsis and is independently associated with poor outcomes. Many studies have shown the ability of renal angina index (RAI) with a cut-off point of 8 to predict the risk of AKI grade 2 and 3, but with varying sensitivity and specificity. Therefore, this study aims to identify a RAI cut-off point to predict the incidence of AKI in pediatric septic patients in the setting of a regional hospital in Indonesia. Methods: An observational analytic study with a prospective longitudinal design was conduct-ed on 30 pediatric patients in the Resuscitation Room of Dr. Soetomo General Hospital Sura-baya. Patients who met the inclusion criteria were given 1-hour standardized resuscitation, then were observed. Every action taken to the patient was recorded, fluid input and output were measured, and mechanical ventilation and vasopressor administration were documented until the third day to determine factors influ-encing the incidence of AKI. Results: In this study, 56.7% of pediatric septic patients had AKI. The Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score in this study had a median of 11, in accordance with the pediatric sepsis guideline. RAI, with a cut-off point of 8 as a predictor for AKI grade 2-3, had a sensitivity of 100% and a specificity of 68% (area under the curve [AUC]=0.912). In terms of AKI risk tranche, the majority of patients (93.1%) had mechanical ventilation, while in terms of AKI injury tranche, the majority met the fluid overload criteria (79.3%). Conclusion: RAI, with a cut-off point of 8, can be used as a predictor for severe AKI in pediatric septic patients

Penggunaan Ventilatory Ratio dan Alveolar Dead Space Fraction sebagai Prediktor Mortalitas pada Pasien COVID-19 dengan Acute Respiratory Distress Syndrome

Abstract Pada pasien COVID-19 dengan ARDS terjadi gangguan oksigenasi dan ventilasi. Menurut kriteria Berlin ARDS, oksigenasi diukur dengan PaO2/FiO2, namun tidak mengukur ventilasi alveolar yang diukur dengan dead space yang dapat terjadi akibat kondisi, seperti kerusakan endotel, mikrotrombus, dan penggunaan ventilator yang berlebih. Tujuan penelitian ini menganalisis penggunaan ventilatory ratio (VR) dan dead space fraction (Vd/Vt) sebagai prediktor mortalitas pasien COVID-19 ARDS. Penelitian ini adalah analitik kohort retrospektif. Data dikumpulkan dari rekam medik pasien COVID-19 yang dirawat di RIK RSUD Dr. Soetomo periode Juni–September 2020 dengan teknik total sampling terhadap subjek yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Data yang dikumpulkan adalah nilai VR dan Vd/Vt (diambil dari data laboratorium), kondisi klinis pasien dan pengaturan ventilator 24 jam pertama setelah terintubasi. Penelitian ini didapatkan 77 dari 80 subjek yang memenuhi kriteria. Nilai VR berhubungan dengan mortalitas secara signifikan dengan nilai p 0,001; cut off 1,84; sensitivitas 84,2%; spesifisitas 85%; RR 30,22; CI 95%: 7,31–124,89. Vd/Vt dan mortalitas menunjukkan hubungan yang signifikan terhadap mortalitas dengan nilai p 0.001. Uji analisis Spearman VR dengan Vd/Vt didapatkan hasil korelasi yang kuat dengan koefisien korelasi 0,704 dan p 0,001. Simpulan, nilai VR dan Vd/Vt dapat digunakan sebagai prediktor mortalitas pasien COVID-19 dengan ARDS dan keduanya mempunyai korelasi yang kuat. VR dapat menggantikan Vd/Vt. Use of Ventilatory Ratio and Alveolar Dead Space Fraction as Predictorz of Mortality in Covid-19 Patients with Acute Respiratory Distress Syndrome COVID-19 with ARDS experience impaired oxygenation and ventilation. In Berlin ARDS criteria, oxygenation is measured by PaO2 /FiO2, but does not measure alveolar ventilation, which is measured through the dead space produced in this conditions, such as endothelial damage, microthrombus, and excessive use of entilator. The purpose of this study was to analyze the use of ventilatory ratio (VR) and dead space fraction (Vd/Vt) as predictors of mortality in patients with COVID-19 ARDS. This study was a retrospective cohort analytic study one medical records of COVID-19 patients treated in an inpatient unit of a referral hospital in Indonesia. The ethical clearance was obtained from the Health Research Ethics Committee of Dr. Soetomo Hospital, Indonesia. Data were collected through total sampling of medical records that met the inclusion and exclusion criteria. The VR and Vd/Vt scores were collected from the laboratory data, patient clinical condition, and ventilator setting 24 hours after intubation. Of all medical records screened, 77 out of 80 samples met the criteria. VR was significantly associated with mortality with a p value of 0.001 (cut-off point:1.84, sensitivity: 84.2%, specificity: 85%, RR: 30.22, and 95%, CI: 7.31–124.89). Similarly, Vd/Vt and mortality showed a significant relationship with mortality with a p value of 0.001 (cut-off: 0.25, sensitivity: 85%, specificity: 86%, RR: 34.71, 95% CI: 8.24–146.05). The Spearman analysis test between VR and Vd/Vt showed a strong correlation with a correlation coefficient of 0,704 and p 0,001. Thus, VR and Vd/Vt can be used as predictors of mortality in COVID-19 patients with ARDS and because both have a strong correlation. VR can also substitute Vd/Vt

Efektivitas Body Surface Area dibanding Predicted Body Weight dalam Menentukan Volume Semenit untuk Mencapai Target PaCO2 pada Operasi Tumor Otak

Latar Belakang dan Tujuan: Manajemen neuroanestesi pada operasi tumor otak bertujuan untuk mencegah terjadinya cedera otak sekunder dan memberikan lapangan operasi yang baik. Hal ini dapat dicapai melalui brain relaxation therapy. Penelitian ini bertujuan menganalisis efektifitas Body Surface Area (BSA) dan Predicted Body Weigh (PBW) untuk menentukan volume semenit dalam mencapai target PaCO2 pada pasien yange menjalani operasi tumor otak. Subjek dan Metode: Penelitian analitik observasional dengan desain cross-sectional melibatkan 31 pasien yang menjalani operasi tumor otak di RSUD Dr Soetomo Surabaya. Pasien yang memenuhi kriteria, dilakukan pengukuran tinggi badan dan berat badan, kemudian dibagi dalam 2 kelompok BSA dan PBW. Kelompok BSA mendapat volume semenit 4xBSA (laki-laki) dan 3.5xBSA (perempuan). Kelompok PBW mendapat volume semenit 100mL/kgBB. Tiga puluh menit setelah pengaturan ventilasi mekanik, dilakukan pemeriksaan analisa gas darah untuk menilai PaCO2. Hasil: Penentuan volume semenit menggunakan BSA menghasilkan volume yang lebih besar dibanding PBW pada pasien normal hingga obesitas.Penggunaan BSA dibanding PBW secara signifikan memiliki PaCO2 lebih rendah (33.55±3.43: 39.29±3.32 mmHg) dengan nilai p=0.0001. Simpulan: Penggunaan BSA dalam menentukan volume semenit efektif dalam mencapai target PaCO2 pada pasien yang menjalani operasi tumor otak

Increase of lung function usage bronchoscopy in COVID-19 patients: Three case series in Indonesian adult

Background COVID-19 is a virus that is spread by aerosol which can cause worsening of hypoxia and bronchoscopy procedures in COVID-19 patients may be considered. Method The design of this study is a case series reported using the Preferred Reporting of Case Series in Surgery (PROCESS) 2020 Guideline. Data collection was carried out in the period January–April 2021. All participants underwent X-ray examination and blood gas analysis as well as signs of infection before and after bronchoscopy. Result Three intubated patients with COVID-19 were confirmed from PCR nasopharyngeal swab present with worsening on chest X-ray. All three patients had a normal bronchial wall with some inflammation and thick mucus resulting in lung atelectasis and massive inhomogeneous opacity on chest X-ray. Patients showed improvement on chest X-ray after bronchoscopy intervention. Conclusion The bronchoscopy procedure can improve the lung function of COVID-19 patients and if it is carried out by medical personnel who pay attention to universal precautions, it will minimize the occurrence of transmission