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

Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis

Background/Objectives: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. Methods: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. Results: Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = −1.99 [95% CI −3.01 to −0.98], p = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], p = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = −1.34 [95% CI −2.29 to −0.40], p = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. Conclusions: Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile

Differences in serum lactate levels, AKI incidence, and intraoperative fluid therapy based on GDFT and standards in major laparotomy surgery patients

This study aimed to analyze the differences in serum lactate levels and the incidence of Acute Kidney Injury (AKI) in GDFT-based and standard liquid therapy in major laparotomy surgery with general anesthesia at Dr Soetomo Hospital. The type of research and research design used is a randomized clinical trials. The research design is an experimental study design. The observed study variables were then followed during surgery up to 48 hours after surgery for data retrieval and measurement. Patients covered by the study were patients who underwent elective major laparotomy at GBPT of Dr Soetomo Hospital. The results revealed that the administration of crystalloid solutions in the standard group was more than that of the GDFT group, while the administration of colloidal solutions in the standard group was less than that of the GDFT group. Intraoperative fluid balance in the standard group were larger compared to the GDFT group. The standard group had higher levels of postoperative serum lactate than the GDFT group (p < 0.001). The incidence of AKI in the standard group was 4 (18.2%) and no AKI incidence was found in the GDFT group.&nbsp

Penggunaan Ventilatory Ratio dan Dead Space Fraction Sebagai Prediktor Mortalitas Pada Pasien COVID-19 dengan Acute Respiratory Distress Syndrome

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 SyndromeCOVID-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.ABSTRAK. Pasien COVID-19 dengan ARDS terjadi gangguan oksigenasi dan ventilasi. Pada kriteria Berlin ARDS, oksigenasi diukur dengan PaO2/FiO2, namun tidak mengukur ventilasi alveolar yang diukur dengan dead space yang bisa terjadi akibat kondisi, seperti: kerusakan endotel, mikro trombus 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. Metode: Penelitian ini analitik kohort retrospektif. Data dikumpulkan dari rekam medik pasien COVID-19 yang dirawat di RIK periode Juni - September 2020. Izin dari Komite Etik Penelitian Kesehatan RSUD Dr. Soetomo. Teknik total sampling yang memenuhi kriteria inklusi dan eksklusi. Nilai dari VR dan Vd/Vt diambil dari data laboratorium, kondisi klinis pasien, setting ventilator 24 jam pertama setelah terintubasi. Hasil: 77 dari 80 sampel yang memenuhi kriteria. VR berhubungan dengan mortalitas secara signifikan dengan nilai p 0.001, cut-off 1.84, sensitifitas 84.2%, spesitifitas 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, cut-off 0.25, sensitifitas 85%, spesitifitas 86%, RR 34.71, CI 95%: 8.24-146.05. Uji analisis Spearman VR dengan Vd/Vt mendapatkan hasil korelasi yang kuat dengan koefisien korelasi 0.704 dan p 0.001. Simpulan: 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.Kata kunci: ARDS, COVID-19, Dead Space Fraction, Mortalitas, Ventilatory Ratio 

Kynurenic acid as chronic pain biomarker for future cancer pain management

The prevalence of chronic pain ranges from 30-50% in patients with cancer undergoing active therapy. Kynurenic acid, xanthurenic acid, and quinolinic acid are significant biomarkers for assessing pain objectively. This study aims to investigate the scientific evidence of the effect of serum kynurenic acid levels on the severity and duration of chronic cancer pain. It is a cross-sectional study with 80 subjects consisting of 19 male and 61 female patients in the palliative outpatient clinic of Dr Soetomo Hospital. The pain assessment was performed using the NRS, and the biochemical analysis of serum kynurenic acid was assessed using the ELISA method. Of the total of 80 subjects, 26 patients had pelvic organ cancer (33.7%), 24 patients had respiratory organ cancer (30.1%), 17 patients had breast cancer (21.7%), 9 patients had abdominal organ cancer (9.6%), 3 patients had malignant melanoma (3.6%), and 1 patient had sternal bone cancer (1.2%). Kynurenic acid significantly correlated with the severity of pain (p = 0.043), with (r) of -0.218. However, kynurenic acid showed no significant correlation with the duration of pain (p = 0.052). Kynurenic acid affected the severity of pain but did not affect the duration of pain in chronic cancer pain patients