Hasil Pencarian  ::  Simpan CSV :: Kembali

"A 46-year-old man was admitted to ICU with a diagnosis at the time of admission of Guillain Barre Syndrome (GBS) and sepsis due to suspected Ventilator-Associated Pneumoniae (VAP). Specimens for the following laboratory workup were inquired, i.e. complete blood count, culture and resistance workup using specimens obtained from the tip of suction pipe, urinalysis and urine culture, blood culture and resistance, procalcitonin and lactate levels. Neutrophilia was found along with increased procalcitonin and lactate levels, which supported the sepsis diagnosis. Moreover, the result of culture from suction pipe demonstrated colonies of Pseudomonas luteola MDRO, which might be originated from the oropharyngeal colonization of the patients due to poor oral hygiene and ineffective oral hygiene nursing; therefore, the colonies of the microorganism were swabbed away when obtaining the specimens. Ineffective oral hygiene nursing may have a potency to cause VAP and recurrent VAP."

"Latar Belakang: Sindroma Guillain-Barre merupakan kondisi kritis dengan kebutuhan energi meningkat sesuai dengan hiperkatabolisme sehingga meningkatkan risiko malnutrisi. Malnutrisi dapat mengurangi kemampuan otot diafragma, dan meningkatkan risiko infeksi yang akan memperberat kondisi sakit kritis. Terapi medik gizi bertujuan menyediakan substrat energi, mengurangi responss metabolik terhadap stres, memicu responss imun, serta mempertahankan massa bebas lemak. Metode: Serial kasus ini melaporkan empat pasien sakit kritis dengan sindroma Guillain-Barre berusia antara 21-58 tahun. Keempat pasien memiliki status gizi obes berdasarkan kriteria World Health Organization WHO Asia Pasifik. Terapi medik gizi diberikan sesuai pedoman pada keadaan sakit kritis dimulai dengan enteral dini dengan target 20-25 kkal/kg BB fase akut dan protein 1,2-2 g/kg BB. Pemberian nutrisi ditingkatkan bertahap sesuai klinis dan toleransi saluran cerna. Mikronutrien diberikan vitamin D3, B, C, seng. Hasil: Tiga pasien pulang dengan perbaikan kekuatan motorik dengan lama perawatan intensif yang bervariasi, sedangkan satu pasien masih dalam perawatan karena membutuhkan ventilasi mekanik. Kesimpulan: Terapi medik gizi adekuat menunjang proses penyembuhan penyakit dan memperbaiki kapasitas fungsional. "

"BackgroundProdromal factors of Guillain-Barre syndrome (GBS) are often associated with previous viral infection (60%). The ailment supported by the acquired immunomediated disorder concept. Viral hepatitis is very rarely found in GBS, preceded by cytomegalovirus (15-18%), Campylobacter jejuni (28%), and Epstein-Barr virus (5%). There is no specific etiology of GBS because those viruses usually appear sporadically (subclinically). All hepatitis virus infection can cause neurological complications, including GBS.Case ReportWe report two cases of hepatitis A virus infection (HAV) in GBS patients in Dr. Sardjito General Hospital during 5 years of observation (1996-2000) from 92 GBS patients. The diagnosis of HAV was based on more than 2 times increment of transaminase enzyme, positive IgM anti HAV, negative HbsAg, and negative IgM ami HCV. The diagnosis of GBS was based on clinical symptoms of acute generalized paralysis, cerebrospinal fluid examination, and electromyelography. In both cases, sub-clinical and sporadic symptoms appeared several days before paralysis, which makes it more likely that the prodromal period of GBS occurred at the same time of HAV incubation period.DiscussionThe incidence of HAV in GBS patients during 5 years of observation was 2%. This corresponds with the case reported by Verona et al, 1996 and Pelletier et al, 1985, i.e. the presence of peripheral neuropathy (n. facialis and n. occulomotorius). Possible alternative pathways for hepatitis virus complicating as GBS are perivascular and endometrial peripheral nerve infiltration by mononuclear cells, T cell sensitization, stimulation of IL-2 growth factor surface receptor, and B cell stimulation. All of the conditions mentioned above causes necrotizing arteritis, vascular occlusion, and at the end, segmental demyelinization. Hepatitis virus may replicate in the central nervous system or peripheral nervous system, subsequently developing into multiple neuropathy disorder and poly arteritis.ConclusionThe diagnoses of HAV and GBS in both cases were established. HAV is one of several viruses that may trigger GBS. In both cases, HAV infection was sub-clinical and sporadic. Symptoms of hepatitis infection subsided along with improvements in the patient's neurological status. Acute viral hepatitis has a wide clinical spectrum and laboratory manifestation that is in accordance with the severity, varying from unclear symptom (anicteric) to jaundice. Acute hepatitis A, B, C infections have the same symptoms in general. However, hepatitis B and C tend to be more severe. The mildest symptoms are transaminase enzyme level increment, no jaundice, gastrointestinal symptoms, flu-like symptoms, and sometimes it can not be diagnosed. The more severe symptoms are jaundice with obvious generalized symptoms.' The incidence of hepatitis A is difficult to be determined accurately because of its characters, i.e. sporadic, endemic, and has a high rate of asymptomatic infection.23-4"

"Pendahuluan: Ventilator Associated Pneumonia (VAP) merupakan infeksi nosokomial yang didapatkan di rumah sakit khususnya di ruang Intensive Care Unit (ICU) pada 48-72 jam paska pemasangan ETT dan Ventilator. Oral care dengan Chlorhexidine merupakan salah satu dari intervensi keperawatan yang bermanfaat dalam menjaga kebersihan mulut dari flora orofaringeal dan kolonisasi mikroorganisme yang berpotensi masuk kedalam saluran nafas karena pemasangan Endotrakheal Tube ( ETT ).Metode: Desain pada penelitian ini menggunakan Randomized Controlled Trial (RCT), untuk menguji efektivitas oral care menggunakan chlorhexidine gel 2% 4 kali sehari dengan cara menggosok gigi dalam menurunkan insiden VAP. Penelitian ini menggunakan teknik random allocation untuk menentuan kelompok kontrol dan kelompok intervensi dan juga menerapkan double blind study. Teknik dalam menentukan sampel pada penelitian ini menggunakan teknik random blok berdasarkan variasi permutasi dibagi menjadi 11 blok kemudian dilakukan random dan  didapatkan total sampel sejumlah 44 yaitu 22 untuk kelompok intervensi dan 22 untuk kelompok kontrol sesuai randome yang didapatkan.Hasil: Pada kelompok kontrol didapatkan hasil sejumlah 9 responden (40,9% ) mengalami VAP, dan sejumlah 13 responden (59,1%) tidak mengalami VAP. Sedangkan untuk kelompok intervensi didapatkan sejumlah 1 responden (4,5%) mengalami VAP, dan sejumlah 21 responden (95,5%) responden tidak mengalami VAP nilai p value  0,012.Kesimpulan: Terdapat perbedaan yang bermakna antara oral care kelompok control dengan kelompok intervensi terhadap insiden VAP.Tindakan keperawatan Oral care dengan chlorhexidine gel 2% 4 kali sehari dengan cara menggosok gigi terbukti efektif dalam menurunkan insiden VAP

---

Introduction: Ventilator Associated Pneumonia (VAP) is a nosocomial infection found in hospitals, especially in the Intensive Care Unit (ICU) room, 48-72 hours after ETT and Ventilator placement. Oral care with Chlorhexidine is one of the nursing interventions that is useful in maintaining oral hygiene from oropharyngeal flora and colonization of microorganisms that have the potential to enter the respiratory tract due to the installation of an Endotracheal Tube (ETT).

Methods: The design of this study used a Randomized Controlled Trial (RCT), to test the effectiveness of oral care using 2% chlorhexidine gel 4 times a day by brushing your teeth in reducing the incidence of VAP. This study uses a random allocation technique to determine the control group and the intervention group and also applies a double blind study. The technique in determining the sample in this study used a random block technique based on permutation variations divided into 11 blocks and then randomized and obtained a total sample of 44, namely 22 for the intervention group and 22 for the control group according to the randome obtained.

Results: In the control group, 9 respondents (40.9%) experienced VAP, and 13 respondents (59.1%) did not experience VAP. As for the intervention group, it was found that 1 respondent (4.5%) experienced VAP, and a number of 21 respondents (95.5%) respondents did not experience VAP with a p value of 0.012.

Conclusion: There is a significant difference between the oral care control group and the intervention group on the incidence of VAP. Oral care with chlorhexidine gel 2% 4 times a day by brushing your teeth is proven effective in reducing the incidence of VAP."

"Ventilator associated-pneumonia VAP adalah pneumonia yang terjadi pada pasien yang terpasang ventilator melalui trakeostomi atau intubasi endotrakeal selama lebih dari 2 hari perawatan. VAP merupakan infeksi yang paling sering terjadi pada ICU dan menjadi penyebab morbiditas mayor, mortalitas, serta peningkatan biaya perawatan. Penelitian retrospective dengan pendekatan cross sectional bertujuan untuk mendapatkan gambaran kejadian VAP pada pasien di ICU RSUD dr. Soedono Madiun bulan Mei 2016 ndash; April 2017. Hasil penelitian menunjukkan sebagian besar pasien yang mengalami VAP adalah berusia dewasa madya 45,2 dengan jenis kelamin laki-laki 52,4 pada late onset 66,7 . Skor komorbiditas rendah 81,0 dan terbesar adalah cedera serebrovaskuler 35,7 . Sering di jumpai bakteri gram negatif 88,1 . Kejadian VAP tinggi disebabkan lama perawatan, kepatuhan klinisi pada pelaksanaan hand hygiene, SOP VAP bundle masih dalam pengembangan, serta mutasi perawat. Penting dilaksanakan penyusunan SOP intervensi VAP bundle yang efektif dan pendokumentasian kejadian VAP sesuai dengan standar CPIS sehingga kejadian VAP dilaporkan tepat.

---

Ventilator associated pneumonia VAP is defined as pneumonia that occured in patient with mechanical ventilation used tracheostomy or endotracheal intubation more than 2 days treatment. VAP is the most common infection in intensive care units ICUs and cause of mortality, major morbidity, and increased finansial burden. This retrospective study with cross sectional approach aimed to explain the VAP incidence of patient in ICU RSUD dr. Soedono Madiun in periode May 2016 until April 2017. The result of this study indicated that the most of patients that developed VAP was median age adult 45,2 male 52,4 late onset VAP 66,7 . The comorbidity score was low 81,0 and the most common was cerebrovascular injury 35,7 . The negative gram bacteria. was the most common microorganism 88,1 . The VAP incidence was high, because of the patient rsquo s length of stay, clinician rsquo s submission of hand hygiene, standard operational procedure of VAP bundle care still unfixed, and staff mutation. So important to arranged effective standard operational procedure of VAP bundle care and appropriate documentation of VAP incidence used CPIS until VAP incidence report was right."

"Latar Belakang: Ventilator-associated pneumonia (VAP) merupakan infeksi yang sering terjadi di intensive care unit (ICU) dan memiliki angka mortalitas yang tinggi. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien. Studi-studi tentang faktor prediktor mortalitas VAP menunjukkan hasil yang berbeda-beda dan tidak ada penelitian yang komprehensif di Indonesia.Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien VAP di RSCM.Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien ICU RSCM yang didiagnosis VAP selama tahun 2003-2012. Data klinis dan laboratorium beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel kelompok usia, infeksi kuman risiko tinggi, komorbiditas, renjatan sepsis, kultur darah, prokalsitonin, ketepatan antibiotik empiris, acute lung injury, skor APACHE-II, dan hipoalbuminemia. Variabel yang memenuhi syarat akan disertakan pada analisis multivariat regresi logistik.Hasil: Sebanyak 201 pasien diikutsertakan pada penelitian ini. Didapatkan angka mortalitas selama perawatan sebesar 57,2%. Kelompok usia, komorbiditas, renjatan sepsis, prokalsitonin, ketepatan antibiotik empiris, dan skor APACHE II merupakan variabel yang berpengaruh terhadap mortalitas pada analisis bivariat. Prediktor mortalitas pada analisis multivariat adalah antibiotik empiris yang tidak tepat (OR 4,70; IK 95% 2,25 sampai 9,82; p < 0,001), prokalsitonin > 1,1 ng/mL (OR 4,09; IK 95% 1,45 sampai 11,54; p = 0,01), usia ≥ 60 tahun (OR 3,71; IK 95% 1,35 sampai 10,20; p = 0,011), dan adanya renjatan sepsis (OR 3,53; IK 95% 1,68 sampai 7,38; p = 0,001).Kesimpulan: Pemberian antibiotik empiris yang tidak tepat, prokalsitonin yang tinggi, usia 60 tahun atau lebih, dan adanya renjatan sepsis merupakan pediktor independen mortalitas pada pasien VAP.

---

Background: Ventilator-associated pneumonia (VAP) is a frequent infection with high mortality rates in intensive care unit (ICU). The prediction of outcome is important in decision-making process. Studies exploring predictors of mortality in patients with VAP produced conflicting results and there are no comprehensive reports in Indonesia.

Objective: To determine predictors of mortality in patients with VAP in Cipto Mangunkusumo Hospital.

Methods: We performed a retrospective cohort study on patients admitted to the ICU who developed VAP between 2003?2012. Clinical and laboratory data along with outcome status (survive or non-survive) were obtained for analysis. We compared age, presence of high risk pathogens infection, presence of comorbidity, septic shock status, blood culture result, procalcitonin, appropriateness of initial antibiotics therapy, presence of acute lung injury, APACHE II score, and serum albumin between the two outcome group. Logistic regression analysis performed to identify independent predictors of mortality.

Results: A total of 201 patients were evaluated in this study. In-hospital mortality rate was 57.2%. Age, comorbidity, septic shock status, procalcitonin, appropriateness of initial antibiotics therapy, and APACHE II score were significantly different between outcome groups. The independent predictors of mortality in multivariate logistic regression analysis were inappropriate initial antibiotics therapy (OR: 4.70; 95% CI 2.25 to 9.82; p < 0.001), procalcitonin > 1.1 ng/mL (OR: 4.09; 95% CI 1.45 to 11.54; p = 0.01), age ≥ 60 years old (OR: 3.71; 95% CI 1.35 to 10.20; p = 0.011), and presence of septic shock (OR: 3.53; 95% CI 1.68 to 7.38; p = 0.001).

Conclusion: Inappropriate initial antibiotic therapy, high serum procalcitonin level, age 60 years or older, and presence of septic shock were independent predictors of mortality in patients with VAP."

"Perawat memiliki peran yang penting untuk mencegah pasien Intensive Care Unit yang terpasang ventilator agar tidak mengalami Ventilator Associated Pneumonia. Penelitian ini bertujuan untuk mengetahui gambaran tingkat pengetahuan perawat Intensive Care Unit terhadap pencegahan Ventilator Associated Pneumonia di RSUP Fatmawati Jakarta. Penelitian ini menggunakan metode cross sectional dengan analisis deskriptif pada 57 perawat Intensive Care Unit. Hasil dari penelitian ini menunjukkan bahwa tingkat pengetahuan perawat Intensive Care Unit RSUP Fatmawati berada dalam kategori sedang dengan persentase 74,04%. Penelitian ini menyarankan untuk perawat mengikuti pelatihan pencegahan Ventilator Associated Pneumonia sebagai upaya peningkatan pengetahuan dan penurunan angka kejadian Ventilator Associated Pneumonia di ruang Intensive Care Unit.

---

Nurses have important role to prevent Ventilator Associated Pneumonia in the mechanically ventilated patients in the Intensive Care Unit. This study aimed to described the level of knowledge of Intensive Care Unit nurses in the prevention of Ventilator Associated Pneumonia at RSUP Fatmawati Jakarta. This study used a cross sectional method with analytic descriptive to 57 nurses. The results of this study showed that the level of knowledge of Intensive Care Unit nurses at RSUP Fatmawati Jakarta are in the average-level with a percentage of 74.04%. This study suggested to following nursing training about Ventilator Associated Pneumonia prevention in order to increasing the knowledge level of Ventilator Associated Pneumonia prevention and as well as reducing the number of Ventilator Assoiated Pneumonia in the Intensive Care Unit."

"Latar Belakang : Sindroma Guillain Barre SGB , menyebabkan pasien gagal napas dan memerlukan perawatan dan pengawasan di unit ruang rawat intensif. Beberapa faktor risiko dipikirkan terhadap terjadinya gagal napas pada SGB, berdasarkan gejala klinis yang timbul saat pasien masuk rumah sakit. Metode : Penelitian ini berdesain potong lintang dengan mengambil data sekunder dari pasien SGB yang menjalani perawatan inap di RSUPNCM sejak Januari 2010-Mei 2018. Data dianalisa dan dilakukan penghitungan dengan multivariat regresi logistik. Hasil : Sebanyak 59 pasien memenuhi kriteria inklusi. Insiden terjadinya gagal napas pada pasien SGB sebesar 25. Kelemahan bulbar OR 26,964; IK 95 2,050-354,616 , disotonomia OR 71,646;IK 3,039-1689,312, dan total skor Medical Research Council MRC OR 0,871; IK 95 0,776-0,978 merupakan 3 variabel yang secara independen berisiko tinggi untuk terjadinya gagal napas pada SGB. Faktor risiko yang tidak berhubungan secara bermakna terhadap kejadian gagal napas adalah usia, riwayat antesenden infeksi, durasi awitan hingga admisi, arefleksia, kelemahan fasial, oftalmopegia, dan tipe patologi SGB. Kesimpulan : Kelemahan bulbar, disotonomia dan total skor MRC merupakan faktor risiko untuk terjadinya gagal napas pada pasien SGB dan disarankan agar mendapatkan perawatan di Intensive Care Unit ICU.

---

Background Guillain Barre Syndrome GBS may cause respiratory insufficiency and requires care and supervision in the Intensive Care Unit. Several risk factors are thought to be the occurrence of respiratory failure in GBS, based on clinical characteristics at hospital admission.

Methods: A cross sectional study was conducted by taking secondary data from GBS patients who were admitted to the Cipto Mangunkusumo hospital from January 2010 to May 2018. Data were analyzed and calculated by multivariate logistic regression.

Results: A total of 59 patients met the inclusion criteria. The incidence of respiratory failure in GBS patients was 25 . Bulbar weakness OR 26,964 95 CI 2,050 354,616 , dysotonomia OR 71,646 95 CI 3,039 1689,312 , and total score of Medical Research Council MRC OR 0,871 95 CI 0,776 0,978 are 3 variables that are independently high risk for the occurrence of respiratory failure in GBS. Risk factors that are not significantly associated with respiratory failure are age, antecedent infection history, duration of onset to admission, areflexia, facial weakness, ophthalmopegia, and type of GBS pathology.

Conclusions: Bulbar weakness, dysotonomia and total MRC score were risk factors for respiratory failure in GBS patients and were advised to receive treatment in the Intensive Care Unit ICU."

"Latar Belakang: Luaran pasien Sindroma Guillain-Barré (SGB) tidak sepenuhnya baik walaupun telah berkembang imunoterapi. Prediksi pasien SGB dengan luaran buruk harus dilakukan sedini mungkin untuk menentukan manajemen selanjutnya di rumah sakit dan perawatan di rumah. Sistem EGOS merupakan salah satu cara untuk memprediksi luaran pasien SGB. Sayangnya, penelitian EGOS selama ini dilakukan di luar negeri yang memiliki kondisi pasien dan lingkungan yang berbeda dengan di Indonesia. Penelitian ini bertujuan mengetahui gambaran luaran pasien SGB melalui skala disabilitas enam bulan pascaawitan dan EGOS di RSUPNCM. Metode: Penelitian ini berdesain potong lintang dengan mengambil data dari rekam medik pasien SGB yang menjalani perawatan inap di RSUPNCM sejak Januari 2010 hingga Desember 2014. Data mengenai karakteristik demografi, klinis, nilai EGOS, dan luaran pasien SGB saat enam bulan pascaawitan dikumpulkan pada penelitian ini. Hasil: Jumlah kasus baru SGB pertahun di RSUPNCM adalah 7,6 kasus. Kasus SGB terjadi di sepanjang tahun dan tidak mengenal musim. Rasio jenis kelamin laki-laki daripada perempuan adalah 1,2 : 1. Rerata usia pasien adalah 39,71 tahun. Varian SGB yang paling sering ditemukan pada penelitian ini adalah AIDP (31,6%), diikuti AMSAN (18,4%), AMAN (15,8%), dan SMF (13,2%). Durasi awitan - RS memiliki median 8,5 hari. Sebanyak 24 pasien mendapat imunoterapi PE, dimana sebanyak 83,3% pasien mendapatkannya pada ≥2 minggu pascaawitan. Proporsi pasien SGB dengan luaran baik sebesar 64,3%. Semakin besar nilai EGOS, maka semakin besar proporsi pasien SGB dengan luaran buruk. Simpulan: Proporsi luaran pasien SGB memiliki kecenderungan tren data yang sejalan dengan prediksi EGOS. Selain itu, proporsi luaran baik pasien SGB dapat lebih ditingkatkan lagi dengan mempercepat diagnosis dan pemberian imunoterapi.

---

Background: The outcome of GBS is not completely well, despite of the development of immunotherapy. Patients with poor outcome have to be identified quickly in order to determine next management in hospital and home care planning. Erasmus GBS Outcome Score (EGOS) is a model to predict the outcome of patients at six months after onset. Unfortunately, the EGOS studies were conducted in foreign countries, which have different patient characteristics and environment. This study was conducted to describe the outcome characteristics and EGOS of GBS patients at Cipto Mangunkusumo Hospital.

Method: A cross-sectional study was conducted to collect data from patient medical records who were admitted to the hospital between January 2010 and December 2014. Data collected included demographic and clinical characteristics, EGOS, and outcome of GBS patients.

Results: New cases of GBS in this hospital were 7.6 cases/ year. Male-to-female ratio was 1.2:1. Mean age was 39.71 years old. The most frequent variant was AIDP (31.6%), followed by AMSAN (18,4%), AMAN (15.8%) and MFS (13.2%). Median duration of onset - hospital was 8.5 days. Twenty four patients were treated with plasma exchange, in which 83.3% got these two weeks after onset. Proportion of patients with good outcome was 64.3%. Higher score of EGOS tend to have higher proportion of patients with poor outcome.

Conclusions: The proportion of GBS patient outcome in this study had a same data trend with EGOS. This proportion of patients with good outcome could be improved with early diagnosis and prompt immunotherapy."