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"Latar belakang. Kejadian demam pascabedah jantung sering ditemukan akibat tindakan pembedahan maupun penggunaan mesin pintas jantung paru (PJP), demam tersebut sulit dibedakan antara demam akibat infeksi atau inflamasi. Penegakan diagnosa infeksi dengan pemeriksaan kultur membutuhkan waktu lama dan kadang tidak tumbuh bakteri. Prokalsitonin (PCT) diharapkan sebagai penanda infeksi tanpa harus menunggu hasil kultur. Tujuan. Penelitian ini bertujuan menilai kadar PCT dapat membedakan demam infeksi dengan demam inflamasi pada pascabedah jantung. Metode. Penelitian ini dikerjakan di Unit Pelayanan Jantung Terpadu RSCM, dengan subyek pasien dewasa pascabedah jantung terbuka dengan menggunakan mesin PJP diikuti selama lima hari adanya demam dengan suhu ≥ 37,8° C, tanda dan gejala infeksi. Semua subyek diperiksa PCT dan kultur darah sebelum pembedahan, hari pertama, kedua dan kelima pascabedah. Pemeriksaan kultur dikerjakan atas indikasi klinis adanya infeksi. Hasil. Sebanyak 59 subyek pascabedah jantung menggunakan mesin PJP, terdapat dua subyek dropout (meninggal pada hari pertama dan kedua), 22 (37,28%) tidak demam, 32 (54,24%) demam inflamasi dan 5 (8,48%) demam infeksi. Infeksi ditemukan dari kultur sputum (Klebsiella pneumonie), hasil kultur darah, luka operasi, dan urin tidak ditemukan pertumbuhan bakteri. Didapatkan kadar PCT demam infeksi 13,48 ng/ ml dan demam inflamasi 6,90 ng/ ml. Simpulan. Kadar PCT demam infeksi (13,48 ng/ ml) lebih tinggi daripada demam inflamasi (6,90 ng/ ml). Tidak ada beda kadar PCT demam infeksi dan demam inflamasi secara statistik dengan p adalah 0,371.

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Background. Post cardiac surgery fevers usually caused by surgery itself or cardiopulmonary bypass (CPB). Difficulties to differentiated fever caused infection or inflammation. Bacterial culture to prove infections take a long time and sometimes the result is negative. Procalcitonin is sugested infection marker without wait for culture.

Goal. The aim of this study is to know procalcitonin level can differentiate fever cause infectious or inflammation.

Methods. This study performed at Integrated Cardiovascular Unit in RSCM, on adult patients who had open cardiac surgery with CPB, observed for temperature ≥ 37,8° C, sign and symptoms of infections, for 5 days. PCT levels and blood culture performed before surgery, first, second and 5th day after surgery. Culture from other sites performed as indicated.

Results. There are 59 have cardiac surgery with CPB, There are two subject dropout (died on 1st and 2nd days), 22 had no fever (37,28%), 32 had inflammation fever (54,24%) and 5 had infectious fever (8,48%). Infection confirmed by bronchial wash culture (Klebsiella pneumonie), no surgical wound infection, blood and urine culture were negative. We have PCT levels infectious group 13,48 ng/ ml and inflammation group 6,90 ng/ ml.

Conclussion. PCT levels infectious group (13,48 ng/ ml) higher than inflammation group (6,90 ng/ ml). Non parametric diagnostic Mann Whitney U test there are no significant differences of PCT levels between infectious and inflammation group, p=0,371."

"Latar Belakang. Hiperglikemia sering terjadi pada pasien pascabedah pintas arteri koroner (BPAK). Kondisi ini mempengaruhi prognosis pada pasien, sehingga dibutuhkan protokol insulin intensif yang efektif dan aman digunakan. Di Indonesia belum ada protokol standar yang terbukti efektif dan aman pada pasien pascabedah pintas arteri koroner (BPAK). Tujuan. Mengetahui persentase pasien pascabedah pintas arteri koroner (BPAK) jantung yang mencapai target glukosa darah dalam 6 jam dan insiden kejadian hipoglikemia dengan menggunakan protokol insulin PERKENI 2011.Metode. Penelitian ini menggunakan desain retrospektif dari rekam medis pasien dewasa 318 tahun yang mengalami hiperglikemia (>200 mg/dL) pascabedah pintas arteri koroner (BPAK). Parameter yang dilihat karakteristik dari subjek, proporsi glukosa darah terkendali (150-200 mg/dL) dalam enam jam dan proporsi hipoglikemia. Proporsi pencapaian glukosa darah ditargetkan >50% dan kejadian hipoglikemia <12%.Hasil. Penelitian ini dilakukan di Pelayanan Jantung Terpadu RSUPN Dr. Cipto Mangunkusumo periode Januari 2018 sampai September 2023. Sebanyak 98 subjek diikutsertakan dan didapatkan persentase pasien yang mencapai target glukosa darah dalam 6 jam sebesar 54,1% dan proporsi hipoglikemia sebesar 5,1%.Kesimpulan. Berdasarkan penelitian ini persentase pasien yang mencapai target glukosa darah dalam 6 jam sebesar 54,1% dan proporsi hipoglikemia sebesar 5,1% dengan menggunakan protokol insulin PERKENI 2011.

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Background. Hyperglycemia often occurs in patients after coronary bypass surgery. This condition affects the patient’s prognosis, so an intensive insulin protocol is needed that is effective and safe to use. In Indonesia, there is no standard protocol that has been proven to be effective and safe in patients after coronary bypass surgery.

Aim. To determine the percentage of post-coronary artery bypass surgery (CABG) patients who achieve blood glucose targets within 6 hours and the incidence of hypoglycemia using the PERKENI 2011 insulin protocol.

Methods. This study used a retrospective design from medical records of adult patients (318 years old) who experienced hyperglycemia (>200 mg/dL) after coronary bypass surgery. The parameters seen were the characteristics of the subjects, proportion of controlled blood glucose (150-200 mg/dL) within six hours and proportion of hypoglycemia. The proportion of blood glucose achieved is targeted at >50% dan the incidence of hypoglycemia <12%.

Results. This research was conducted at the Integrated Heart Service of RSUPN Dr. Cipto Mangunkusumo for the period January 2018 to September 2023. A total of 98 subjects were included and it was found that the percentage of patients who reach the blood glucose target within 6 hours was 54.1% and the proportion of hypoglycemia was 5.1%.

Conclusion. Based on this study, the percentage of patients who achieved the blood glucose target within 6 hours was 54.1% and the proportion of hypoglycemia was 5.1% using the PERKENI 2011 insulin protocol."

"ABSTRAKPendahuluan Infeksi pneumonia nosokomial (PN) merupakan masalah utama di negara berkembang terutama pada pasien yang menjalani bedah jantung dan mendapat perawatan di intensive care unit (ICU). Aspirasi mikroorganisme dari kolonisasi rongga mulut merupakan salah satu faktor risiko PN yang perlu diperhatikan. Tujuan penelitian ini adalah untuk mengetahui dapat tidaknya kondisi rongga mulut menjadi prediktor terjadinya PN. Metode Penelitian ini adalah penelitian kohort prospektif. Subjek penelitian merupakan pasien bedah jantung elektif. Kondisi rongga mulut diwakili oleh oral hygiene index - simplified (OHI-S), decay missing filled - teeth (DMF-T) serta laju aliran saliva tanpa stimulasi (LASTS) diukur pada prabedah dan pascabedah. Terjadinya PN dinilai melalui dua parameter diagnosis yaitu clinical pulmonary infection score (CPIS) dan PN yang didiagnosis berdasarkan pengkajian klinis dokter (diagnosis klinis PN). Hasil Pada penelitian ini didapatkan 35 subyek penelitian yang memenuhi kriteria inklusi selama Desember 2012 hingga Maret 2013. Hasil analisis statistik tidak menunjukkan kemaknaan hubungan antara OHI-S, DMF-T, LASTS dengan CPIS(p=0,420; p=0,268; p=0,949). Demikian pula dengan OHI-S, DMF-T tidak terbukti mempunyai hubungan dengan diagnosis klinis PN (p=0,484; p=0,656). Namun, LASTS mempunyai hubungan signifikan dengan diagnosis klinis PN (p=0,017). Rerata LASTS pascabedah mengalami penurunan bermakna dibandingkan dengan prabedah (p=0,000). Kesimpulan Dalam penelitian ini, kondisi rongga mulut belum dapat terbukti sebagai prediktor terjadinya PN walaupun terdapat hubungan antara LASTS dengan PN yang didiagnosis melalui pengkajian klinis dokter.

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ABSTRACTIntroduction Nosocomial pneumonia (NP) is a major problem in developing countries, particularly in patients undergoing cardiac surgery and who received treatment in the intensive care unit (ICU). Aspiration of oral microorganism colonization is one of the substantial risk factors. The aim of this study was to determine whether the condition of the oral cavity can be a predictor of NP. Methods A cohort prospective study was performed in this study. Subjects are elective cardiac surgery patients. Oral conditions examination defined by oral hygiene index ? simplified (OHI-S), decay missing filled - teeth (DMF-T) and unstimulated salivary flow rate (SFR) was implemented pre-surgery and post-surgery. Diagnosis of NP was evaluated through two parameters. There were clinical pulmonary infection score (CPIS) and clinical assessment of NP. Results There were 35 subjects participating in this study who meet inclusion criteria since December, 2012 to March, 2013. Statistic analyses have not been able to confirm the link between OHI-S, DMF-T, SFR to CPIS (p=0.420; p=0.268; p=0.949). Similarly, relation of OHI-S, DMF-T and clinical NP has not proven (p=0.484; p=0.656). However, SFR was significantly related to clinical assessment of NP (p=0.017). The mean of post-surgery SFR was remarkably lower than pre-surgery (p=0.000). Conclusions In this study, the oral conditions have not been shown to be predictors of the occurrence of PN although there is a link between SFR and clinical assessment of NP."