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All Journal Jurnal Anestesi Perioperatif Majalah Anestesia dan Critical Care
Erwin Pradian
Departemen Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Education Health Professions Medicine & Pharmacology

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Gambaran Acute Physiologic and Chronic Health Evaluation (APACHE) II, Lama Perawatan, dan Luaran Pasien di Ruang Perawatan Intensif Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung pada Tahun 2017 Pamugar, Bramantyo; Pradian, Erwin; Fuadi, Iwan
Jurnal Anestesi Perioperatif Vol 6, No 3 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (850.734 KB) | DOI: 10.15851/jap.v6n3.1344

Abstract

Skor acute physiologic and chronic health evaluation (APACHE) II, lama perawatan, dan luaran pasien merupakan indikator penting di Intensive Care Unit (ICU). Ketiga indikator ini dapat berbeda dari satu dengan tempat lain. Ketiga indikator ini dapat dibandingkan di tempat lain untuk meningkatkan pelayanan ICU. Tujuan penelitian ini adalah mengetahui gambaran skor APACHE II, lama perawatan, dan angka mortalitas pada pasien yang dirawat di ICU RSUP Dr. Hasan Sadikin Bandung pada tahun 2017. Metode yang digunakan adalah deskriptif observasional yang dilakukan secara retrospektif terhadap 303 objek penelitian. Objek penelitian diambil di bagian rekam medis pada bulan April 2018. Penelitian ini memperoleh hasil skor APACHE II berkisar 0−56  dengan rerata 16,68, angka mortalitas sebesar 130 (42,3%), dan lama perawatan berkisar 2−79 hari dengan rerata 9,89 hari. Data skor APACHE II terhadap angka kematian berbeda dengan Amerika Serikat yang dapat dikarenakan perbedaan acuan prediksi mortalitas, underestimation derajat keparahan pasien cedera kepala, bias yang disebabkan oleh penatalaksanaan pasien pre-ICU, dan satu waktu pemeriksaan skor APACHE II.Kata kunci: APACHE II, ICU, lama perawatan, luaran pasienOverview of Acute Physiologic and Chronic Health Evaluation (APACHE) II, Length of Stay, and Patient Outcome in the Intensive Care Unit of Dr. Hasan Sadikin General Hospital in 2017The APACHE II score, length of stay, and patient outcome are important indicators in Intensive Care Unit (ICU). Those indicators could be different from one place to another and can be compared to increase the quality of health services in ICU. The purpose of this study was to describe acute physiologic and chronic health evaluation (APACHE) II, length of stay, and mortality rate of patients at the ICU of Dr. Hasan Sadikin General Hospital Bandung from January 1 to December 31, 2017. This was a retrospective descriptive observational study on 303 patient medical records. It was revealed that the APACHE score was ranging from 0−56 (mean =16.68); the mortality rate was 42.9% (n=130); and the length of stay was 2−79 days (mean 9.89 days). This suggests a gap in these indicators between Dr. Hasan Sadikin General Hospital and hospitals in the United States of America which may be due to differences in the the standard that is used to predict the mortality rate, underestimation of severity of head injury, treatment before admission to ICU, and single time assessment of APACHE II.Key words: APACHE II, ICU, length of stay, outcome
Acid-Base Balance: Stewart’s Approach Pradian, Erwin; Maskoen, Tinni Trihartini; Destiara, Andy Pawana
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Abstract

The Henderson-Hasselbalch approach to acid-base balance allows explanation and quantification of many disorders of acid-base phisiology and is still widely used in clinical practice. However, complex metabolic disorders, such as those present in critically ill patients, can be difficult to define and treat using this approach. Peter Stewart proposed a different approach to acid-base physiology based upon physicochemical principles, which are electrochemical neutrality, conservation of mass and law of mass action. According to Stewart, there are only three variables influence the dissociation of water. These independent variables are pCO2, total concentration of weak acid [ATot] and strong ion difference (SID). Another different is if in Henderson-Hasselbalch approach pointed on bicarbonat ion, Stewart use chloride ion as the important anion as the causatif factor so there are also known the terms hyperchloremia acidosis, dilutional acidosis and contraction alkalosis.
Clinical Manifestations of Iscehaemic and Reperfusion Injury Pradian, Erwin; , Rizki; Maskoen, Tinni Trihartini
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Abstract

Although restoration of blood low to an ischaemic organ is essential to prevent irreversible tissue injury, reperfusionper se may result in a local and systemic inlammatory response that may augment tissue injury in excess of thatproduced by ischaemia alone. Cellular damage after reperfusion of previously viable ischaemic tissues is deinedas ischaemia-reperfusion (I-R) injury. I-R injury is characterized by oxidant production, complement activation,leucocyte endothelial cell adhesion, platelet-leucocyte aggregation, increased microvascular permeability anddecreased endothelium-dependent relaxation. In its severest form, I-R injury can lead to multiorgan dysfunctionor death. Although our understanding of the pathophysiology of I-R injury has advanced signiicantly in the lastdecade, such experimentally derived concepts have yet to be fully integrated into clinical practice. Treatment ofI-R injury is also confounded by the fact that inhibition of I-R-associated inlammation might disrupt protectivephysiological responses or result in immunosuppression. Thus, while timely reperfusion of the ischaemic areaat risk remains the cornerstone of clinical practice, therapeutic strategies such as ischaemic preconditioning,controlled reperfusion, and anti-oxidant, complement or neutrophil therapy may signiicantly prevent or limit I-Rinducedinjury in humans.
Pengaruh Anestesi Umum dibanding dengan Anestesi Spinal untuk Seksio Sesarea terhadap Suhu Rektum Bayi Baru Lahir Rahmat, Rahmat; Pradian, Erwin; Boom, Cindy Elfira
Majalah Anestesia dan Critical Care Vol 34 No 3 (2016): Oktober
Publisher : Perdatin Pusat

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Abstract

Teknik anestesi spinal dan anestesi umum keduanya mengganggu mekanisme termoregulasi. Masih kurang informasi tentang pengaruh teknik anestesi yang dipakai untuk seksio sesarea terhadap suhu tubuh bayi baru lahir. Tujuan penelitian ini untuk menentukan apakah ada perbedaan suhu rektum bayi baru lahir dengan seksio sesarea dihubungkan dengan teknik anestesi yang dipakai. Wanita hamil sebanyak 60 orang secara acak mendapat anestesi umum atau anestesi spinal. Suhu inti ibu diukur tiga kali dengan termometer membran timpani saat induksi, insisi uterus dan saat bayi lahir. Suhu rektum bayi diukur segera setelah lahir. Usia ibu, berat badan, tinggi badan, body mass index (BMI), suhu ibu sesaat sebelum induksi dan suhu ruangan tidak berbeda bermakna pada kedua kelompok. Interval waktu mulai induksi anestesi sampai bayi lahir pada kelompok anestesi spinal ratarata 18,24 menit (SD=2,862) dan kelompok anestesi umum rata-rata 6,47 menit (SD=3,082).Volume cairan pada kelompok anestesi spinal rata-rata 946,6 mL (SD=225,57) dan pada kelompok anestesi umum rata-rata 715,0 mL (SD=133,36), nilai P<0,05. Suhu rektum bayi pada kelompok anestesi spinal rata-rata 37,19oC (SD=0,256) dan pada kelompok anestesi umum rata-rata 37,59oC (SD=0,2288), nilai P<0.05. Suhu rektum bayi lebih rendah padakelompok anestesi spinal dibanding dengan kelompok anestesi umum, tetapi tidak mencapai batas hipotermi. Hal ini akibat pada anestesi spinal terjadi redistribusi panas dari inti ke perifer yang lebih besar, pada penelitian ini ditemukan pula pada anestesi spinal memerlukan lebih banyak cairan intravena dan Interval mulai anestesi sampai bayi lahir lebih panjang. Kata kunci: Anestesi spinal, anestesi umum, suhu membran timpani, suhu rektum bayi, seksio sesarea The Effect Of General Anesthesia Compared to Spinal Anesthesia in Cesarian Section on Newborn Rectal TemperatureBoth spinal anesthesia and general anesthesia interfere thermoregulation mechanism. There are less information on the effect of anesthesia technique applied in cesarean section on newborn rectal temperature. The aim of the study was to determine whether there was a different rectal temperature of the newborn babies with cesarean section in related to using different anesthesia techniques. Sixty pregnant women were randomLy assigned either to general anesthesia group or spinal anesthesia group. The maternal core temperature was measured triplicately with tympanic membrane thermometer at induction, uterine incision, and birth. The rectal temperature of thebabies was promptly measured after delivery. The age, weight, height, BMI, and temperature before induction of the mothers, as well as the room temperature were non-significantly different in both groups. The mean time interval, from anesthesia induction to infant delivery in spinal anesthesia was 18.24 (SD=2.862) minutes and that in general anesthesia was 6.47 (SD=3.082). The mean fluid volume in spinal anesthesia was 946.6 (SD=225.57) mL and that in general anesthesia was 715.0 (SD=133.36) mL, with P<0.05. The mean infant rectal temperature in spinal anesthesia was 37.19 (SD=0.256) °C and that in general anesthesia was 37.59 (SD=0.2288) °C, with p<0.05. The infant rectal temperature was lower in spinal anesthesia compared to that in general anesthesia; but it did notreach hypothermic limit. This was due to that in the spinal anesthesia, there are a greater heat redistribution from core to periphery, a need of more intravenous fluid, and a prolonged interval from anesthesia initiation to infant birth. Key words: Cesarean section, general anesthesia, newborn rectal temperature, spinal anesthesia, tympanicmembrane temperature
Resuscitative Strategies in Traumatic Hemorrhagic Shock Supandji, Mia; Budipratama, Dhany; Pradian, Erwin
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Abstract

Trauma and brain injury are common in young patients with a high incidence of mortality. The classic triadof death in a trauma involves hypothermia, acidosis and coagulopathy. This physiologic derangement plays animportant role in exsanguination and death of trauma patients, if it is not promptly diagnosed and aggressivelytreated. However, the optimal strategy is still debatable. Damage Control Resuscitation along with damage controlsurgery has been proven to increase patients survival. DCR is a management of patients with trauma startedfrom the emergency room up to the operating room and the intensive care unit (ICU). Five pillars of DCR are 1.Body rewarming, 2. Correction of acidosis, 3. Permissive hypotension, 4. Restrictive luids administration and 5.Hemostatic resuscitation. Early and aggressive transfusion of blood and blood products, with comparison of PRC,FFP and platelets of 1:1:1, if no whole blood available, can improve the outcome and survival of the patients.
NutritionTherapy in ICU Patiens Kestriani, Nurita Dian; Budipratama, Dhany; Pradian, Erwin
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
Publisher : Perdatin Pusat

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Abstract

Under ordinary circumstances, feeding is not considered as medical therapy. When normal diet fail to meet daily requirements or when assessment documents deficiencies, then nutritional planning becomes a part of medical therapeutics. The goals of nutritional support for critically ill patients include preserving tissue mass, decreasing usage of endogenous nutrient stores and catabolism, and maintaining or improving organ function (i.e., immune, renal, and hepatic systems; muscle). Specific goals include improving wound healing, decreasing infection, maintaining the gut barrier (decreasing translocation), and decreasing morbidity and mortality all of which may contribute to decreasing the ICU or hospital stay and hospitalization costs.
Co-Authors , Rizki - Irwan, - - Suhandoko A. Muthalib Nawawi Agung Hujjatulislam, Agung Andie Muhari Barzah, Andie Muhari Budi Fitriyana Cindy Elfira Boom Dedi Fitri Yadi Delis, Eddo Alan Destiara, Andy Pawana Dhany Budipratama Doni Arief Rahmansyah Emvina Husni Syam Eri Surahman Faisal Rosady Gunawan, Aris Hendro, Rachmad Try Ida Bagus Krisna Jaya Sutawan Ike Sri Redjeki Indriasari Indriasari Iwan Fuadi Kurniawan, Muhammad Budi Maransdyka Purnamasidi Mohamad Andy Prihartono Nawawi, Muthalib Nurita Dian Kestriani Pamugar, Bramantyo Permana, Sendy Setiawan Rahmat Rahmat Reza Indra Putra, Reza Indra Rudi Kurniadi Kadarsah Ruli Herman Sitanggang Selly Oktarina Rosita Supandji, Mia Susanto, Bahtiar Tatang Bisri Tinni T. Maskoen Tinni Trihartini Maskoen Yovita Koswara