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Pasien anak sakit kritis yang memakai ventilasi mekanik maupun tidak, membutuhkan obat penenang dan atau analgesik untuk mengurangi kecemasan atau rasa sakit. Perawat memiliki peranan penting dalam penilaian sedasi secara kontinu, perawat bertanggung jawab memantau tingkat sedasi pasien sehingga mampu melaporkan status sedasi pasien secara tepat. Studi literatur ini bertujuan untuk meninjau lebih lanjut validitas dan reliabilitas instrumen Comfort Behaviour Scale. Pencarian literatur dilakukan dengan memanfaatkan platform publikasi internet periode studi 2011-2020 melalui Scopus, Proquest, Wiley Online library, serta sumber tambahan dari Researchgate dengan kata kunci pain assessment, COMFORT Behaviour Scale, sedation, children, PICU. Hasil studi literatur ini menunjukkan berbagai penelitian di beberapa negara dan instrumen Comfort Behaviour Scale terbukti valid dan reliabel digunakan dalam mengukur tingkat sedasi anak sakit kritis. Perawat disarankan menggunakan instrumen ini dalam manajemen nyeri dan sedasi yang komprehensif.

 

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Critically ill pediatric patients induced with or without mechanical ventilation need sedatives or analgesics to reduce their anxiety or pain. Nurses have an important role to asses sedation continuously and responsible to monitor patients sedation level, in order to record the patients sedation status appropriately. This literature study aims to profoundly review the validity and reliability of the Comfort Behavior Scale instrument. The literature research is carried out by utilizing the internet publication platform from 2011 to 2020 through Scopus, Proquest, Wiley Online library, as well as additional resources from Researchgate with the keywords pain assessment, COMFORT Behavior Scale, sedation, children and PICU. The results of this literature study show various studies in several countries have proven the validity and reliability of Comfort Behavior Scale instrument as the instrument to measure the sedation level of critically ill children. Nurses are considered to utilize this instrument in pain management and in conducting comprehensive sedation

 

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"Penggunaan antibiotik yang tidak rasional menyebabkan resistensi antibiotik di seluruh dunia. Berbagai upaya telah dilakukan untuk mencegah resistensi antibiotik. Penelitian ini bertujuan untuk melakukan evaluasi hubungan antara penggunaan antibiotik sesuai rekomendasi Pedoman Penggunaan Antibiotik (PPAB) dengan luaran klinis, luaran laboratorium, lama rawat dan luaran sekunder yang membaik pada anak dengan infeksi yang di rawat di ruang intensif anak. Penelitian ini menggunakan desain kohort retrospektif pada anak usia 1-18 tahun yang mendapat terapi antibiotik. Hasil penelitian, dari 85 anak, terdapat 126 penggunaan antibiotik, rerata usia 4,9 tahun, sebaran profil bakteri Gram negatif lebih banyak dibanding Gram positif, sebaran penggunaan antibiotik empiris sesuai rekomendasi PPAB (69,8%) menurut alur Gyssens merupakan kategori 0 (penggunaan antibiotik tepat). Berdasarkan analisis bivariat, variabel luaran klinis, luaran laboratorium, lama rawat dan luaran sekunder tidak  memiliki hubungan bermakna dengan penggunaan antibiotik sesuai PPAB (p>0,05). Sebagai saran, sosialisasi rutin oleh tim PPRA, evaluasi panduan PPAB terus diperbarui tiap 3-6 bulan sesuai data uji kepekaan antibiotik terbaru. Penelitian lebih lanjut diperlukan untuk evaluasi penggunaan antibiotik, secara prospektif dengan subyek yang lebih banyak, durasi lebih lama, kriteria inklusi yang lebih spesifik tanpa komorbid untuk memperkuat rekomendasi penggunaan antibiotik yang sesuai PPAB.

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The irrational use of antibiotics causes antibiotic resistance worldwide. Various attempts have been made to prevent antibiotic resistance. This study aims to evaluate the relationship between the use of antibiotics according to PPAB recommendations and improved clinical outcomes, laboratory outcomes, length of stay and secondary outcomes in children with infections treated in the pediatric intensive care unit. This study used a retrospective cohort design in children aged 1-18 years who received antibiotic therapy. The results of the study, of 85 children, there are 126 antibiotic use, the mean age was 4,9 years, the distribution of Gram-negative bacteria profiles was more than Gram-positive, the distribution of empirical antibiotic use according to PPAB recommendations 69.8% according to the Gyssens flow is category 0 (appropriate use of antibiotics). Based on bivariate analysis, the clinical outcome variables, length of stay, laboratory outcomes and secondary outcomes had a p value > 0.05 which were statistically not significantly different to have a relationship with the use of antibiotics according to PPAB. As a suggestion, regular socialization by the PPRA team and evaluation of the PPAB guidelines are continuously updated every 6 months according to the latest antibiotic sensitivity test data. Further research is needed to evaluate the use of antibiotics, prospectively with more subjects, longer duration, more specific inclusion criteria without comorbidities to strengthen recommendations for the use of antibiotics according to PPAB."