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"Latar Belakang: Intensive care unit-acquired weakness (ICU-AW) adalah salah satu masalah yang dihadapi dalam manajemen pasien kritis karena dihubungkan dengan ventilasi mekanik berkepanjangan sehingga meningkatkan risiko komplikasi dan mortalitas selama di ICU. Mobilisasi dini seperti neuromuscular electrical stimulation (NMES) dilaporkan bermanfaat mengurangi durasi penggunaan ventilator di ICU. Telaah sistematik dan meta-analisis ini dibuat untuk menyimpulkan dampak dari NMES terhadap durasi penggunaan ventilator di ICU. Tujuan: Mengetahui dampak spesifik penggunaan NMES terhadap durasi penggunaan ventilator pada pasien ICU. Metode: Studi eligibel hingga Januari 2022 terinklusi dalam studi. Pencarian literatur dilakukan melalui database jurnal berbasis elektronik yaitu Cochrane, EBSCOHost, Scopus, dan Pubmed dengan kata kunci spesifik dan operator boolean. Studi terinklusi dievaluasi untuk risiko bias dengan Cochrane RoB 2 dan estimasi besar efek dilakukan dengan fixed effect model menggunakan perangkat lunak Review Manager 5.4. Hasil: Pencarian literatur menghasilkan 9 studi yang terinklusi dalam meta-analisis. Dari penggabungan data, disimpulkan bahwa penggunaan NMES berhubungan dengan penurunan durasi penggunaan ventilator (MD -1.48; 95% CI: -2,54 – -0,41, p = 0,007, I 2 =30%, fixed-effect modelling). Kesimpulan: Penelitian ini menyimpulkan bahwa pemberian NMES dapat menurunkan durasi penggunaan ventilator di ICU.

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Background: Intensive Care Unit-Acquired Weakness (ICU-AW) is one of the problems faced in critical medicine management, associated with prolonged mechanical ventilation (PMV) thereby increasing risk and mortality while in the ICU. Early mobilization such as neuromuscular electrical stimulation (NMES) has been reported to be beneficial in reducing the duration of mechanical ventilation in the ICU. This systematic review and meta-analysis was conducted to conclude the impact of NMES on the duration of mechanical ventilation in the ICU. Objective: To determine the impact of the use of NMES on duration of mechanical ventilation in ICU patients. Methods: Eligible studies up to January 2022 were included in the study. The literature search was carried out through electronic-based journal databases, namely Cochrane, EBSCOHost, Scopus, and Pubmed with specific keywords and boolean operators. The included studies were evaluated for risk of bias with Cochrane RoB 2 and estimation of effect size was performed using a fixed effect modelling using Review Manager 5.4 software. Results: The literature search yielded 9 studies that were included in the meta- analysis. From the pooled data, it was concluded that NMES administration was associated with a decrease in the duration of mechanical ventilation (MD -1.48; 95% CI: -2.54 – -0.41, p = 0.007, I2 = 30%, fixed-effect modeling). Conclusion: This study concluded that the administration of NMES reduces the duration of ventilator use in the ICU."

"This trusted guide is written from the perspective of authors who have more than seventy-five years' experience as clinicians, educators, researchers, and authors. Featuring chapters that are concise, focused, and practical, this book is unique. Unlike other references on the topic, this resource is about mechanical ventilation rather than mechanical ventilators. It is written to provide a solid understanding of the general principles and essential foundational knowledge of mechanical ventilation as required by respiratory therapists and critical care physicians. To make it clinically relevant, Essentials of Mechanical Ventilation includes disease-specific chapters related to mechanical ventilation in these conditions"--Publisher's description"

"ABSTRAKSalah satu upaya dalam mencegah terjadinya komplikasi infeksi di intensive care unit dengan memonitoring pH cairan lambung khususnya pada pasien terpasang ventilasi mekanik. Penelitian ini bertujuan mengidentifikasi perbedaan pemberian nutrisi enteral metode intermittent dan bolus feeding terhadap pH cairan lambung pasien dengan ventilasi mekanik. Penelitian ini menggunakan desain quasi experiment pada 30 responden. Kelompok pertama (15 responden) mendapatkan intervensi intermittent feeding dan kelompok kedua (15 responden) mendapatkan intervensi bolus feeding. Uji perbedaan hasil menggunakan chi-square, pooled t test dan paired t test. Hasil penelitian (between groups) menunjukkan adanya perbedaan pH cairan lambung yang bermakna pada kelompok yang mendapatkan terapi nutrisi enteral metode intermittent dan bolus feeding pada pasien dengan ventilasi mekanik (p < 0,05). Penelitian merekomendasi perawat untuk dapat melakukan tindakan pemberian nutrisi enteral dengan metode yang tepat dan berupaya menerapkan tindakan pencegahan terhadap komplikasi lebih lanjut akibat pemberian nutrisi enteral sehingga akan memperbaiki sistem layanan asuhan keperawatan.

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ABSTRACTOne of the most common strategy to prevent infection complications in intensive care unit by monitoring pH gastric especially to patients with mechanical ventilation. The purpose of this study is to identify the difference intermittent and bolus feeding to pH gastric in patients with mechanical ventilation. The study design quacy experiment with sample of 30 respondents. First group (15 respondents) getting intermittent feeding and second group (15 respondents) getting bolus feeding. Data were analyzed using chi-square, pooled t test and paired t test. The results showed that there is a significant different of pH gastric between intermittent feeding and bolus feeding in patient with mechanical ventilation (p <0.05). Further study recommends nurses to provision enteral nutrition with right method and sought to apply complication preventive by the result of enteral nutrition."

"ABSTRAKKesulitan berkomunikasi merupakan stressor yang paling berat bagi pasien yang menggunakan ventilasi mekanis. Ketidakmampuan berkomunikasi karena penggunaan alat bantu nafas dapat menyebabkan ansietas. Komunikasi efektif dapat membantu menurunkan ansietas dan kesulitan berkomunikasi. Tujuan penelitian ini untuk mengetahui perbandingan efektifitas writing board dan communication board dalam menurunkan ansietas dan kesulitan berkomunikasi pasien dengan ventilasi mekanis. Desain penelitian menggunakan quasi eksperimen dengan pre-post test without control grup pada 24 pasien yang menggunakan ventilasi mekanis di ruang rawat intensif. Hasil penelitian menunjukkan pengaruh yang signifikan pada penurunan ansietas dan kesulitan berkomunikasi sebelum dan sesudah intervensi baik pada kelompok writing board maupun communication board p value < 0,05 , namun tidak ada perbedaan penurunan ansietas dan kesulitan berkomunikasi antara kedua kelompok tersebut p value > 0,05 . Hasil penelitian ini menunjukkan bahwa writing board dan communication board dapat direkomendasikan menjadi alternatif metode komunikasi yang efektif digunakan pada pasien yang menggunakan ventilasi mekanis di ICU.

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ABSTRACTCommunication difficulties is the most severe stressor for patients receiving mechanical ventilation. Inability to communicate due to the use of ventilatory support can cause anxiety. Effective communication can help reduce anxiety and communication difficulties. This study aimed to compare the effectiveness of writing board and communication board in lowering anxiety and communication difficulties in patients receiving mechanical ventilation. A total of 24 intensive care patients receiving mechanical ventilation, were included in this quasi experimental study that involved pre and post test without control group. The results showed a significant effect on the reduction of anxiety and communication difficulties before and after intervention in both communication board and writing board group p value 0.05 . This study results showed that writing board and communication board could be recommended as an effective alternative method of communication used in intensive care patients receiving mechanical ventilation "

"ABSTRAKPasien yang terpasang ventilator mengalami kesulitan berbicara sehingga mengalami gangguan dalam berkomunikasi dan menggunakan suatu metode dalam berkomunikasi. Penelitian ini menggunakan desain crossectional dengan sampel 45 responden dan tekhnik pengumpulan data purposive sampling. Hasil penelitian menunjukkan metode komunikasi yang digunakan pasien yaitu menunjuk atau membuat isyarat dengan tangan yang digunakan 100% responden, menulis atau menggambar yang digunakan 40% responden, menggerakkan bibir atau mencoba untuk berbisik yang digunakan 91% responden, ekspresi wajah yang digunakan 84% responden, dan menggerakkan kepala, ya atau tidak yang digunakan 93% responden. Metode komunikasi lain yang digunakan adalah mengetuk tempat tidur. Perawat diharapkan mengetahui metode komunikasi yang digunakan pasien yang terpasang ventilator sehingga dapat memberikan penjelasan tentang pilihan metode komunikasi sesuai keadaan pasien serta menyediakan media sesuai metode komunikasi yang dipilih.

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ABSTRAKPatients who have difficulty speaking with mechanical ventilation so that impaired communication and uses a method of communicating. This study used crosssectional design with a sample of 45 respondents and data collection purposive sampling technique. The results showed that method of communication used by patients to refer or make a gesture with the hand were used 100% by the respondents, writing or drawing were used 40% by respondents, moving his lips or trying to whisper were used 91% by respondents, the facial expression were used 84% by respondents, and move his head, yes or not were used 93% by respondents. Another communication method which was used by the patient is knocking on the bed. Nurses are expected to know the method of communication used by patients with mechanical ventilation in order to provide an explanation of the preferred method of communication according to the situation of patients and provide appropriate media communication method selected."

"Latar Belakang: Coronavirus Disease (COVID-19) adalah penyakit yang menjadi pandemi diseluruh dunia sejak awal tahun 2020 dengan memiliki angka kematian yang tinggi. Derajat klinis COVID-19 beragam dari mulai ringan hingga kritis. Pasien COVID-19 derajat kritis dengan kondisi sindrom gawat napas akut (ARDS) yang menggunakan ventilasi mekanis memiliki angka kematian yang tinggi. Penelitian yang berfokus kepada lama kesintasan pasien COVID-19 derajat kritis dengan ventilasi mekanis terutama di Indonesia masih belum banyak dilakukan.Metode Penelitian: Penelitian ini merupakan penelitian kohort retrospektif dengan analisis kesintasan pada pasien COVID-19 derajat kritis yang menggunakan ventilasi mekanis dalam rentang Maret 2020 sampai September 2020. Pengambilan sampel dilakukan secara consecutive sampling dan data subjek yang memenuhui kriteria inklusi diambil dari rekam medis. Hasil Penelitian: Terdapat 70 subjek, 51 subjek memiliki kelengkapan rekam medis dan sesuai dengan kriteria inklusi dan eksklusi. Mayoritas subjek merupakan laki-laki (58,8%), rerata usia subjek 55,98 tahun (+ 11,96) dengan median IMT 23,9 kg/m2(17-54). Median durasi penggunaan ventilasi mekanis 4 hari (1-20) dengan angka kesintasan 7,8% dan kematian 92,2%. Nilai median kadar PaO2/FiO2 72 mmHg (31-606) dengan mayoritas sindom gawat napas akut derajat berat (84,3%). Median kesintasan pasien COVID-19 derajat kritis dengan ventilasi mekanis adalah 4 hari (IK95% ; 3,139-4,861) dan rerata kesintasan 5,5 hari (IK95% ; 4,213-6,922). Median kesintasan subjek dengan sindrom gawat napas akut berat adalah 4 hari (IK95% ; 3,223-4,777). Median kesintasan subjek tanpa sindrom gawat napas akut berat adalah 6 hari (IK95% ; 2,799-9,201) HR 0,802 (IK95% ; 0,337-1,911) p = 0,619. Median kesintasan subjek dengan hiperkapnia adalah 2 hari (IK95% ; 0,00-4,006) HR 0,613 (IK95% ; 0,3030-1,242) dan p = 0,174. Median kesintasan subjek dengan hiponatremia adalah 3 hari (IK95% ; 2,157-3,843) HR 0,897 (IK95% ; 0,5-1,610) p = 0,716. Median kesintasan subjek dengan hiperkalemia adalah 2 hari (IK95% 2,0-2,0) HR 0,293 (IK95% ; 0,061-1,419) p = 0,127.Kesimpulan: Angka kesintasan pasien COVID-19 derajat kritis dengan ventilasi mekanis pada awal pandemi memiliki angka yang rendah dengan lama kesintasan selama 4 hari. Derajat sindrom gawat napas akut sebelum intubasi, hiperkapnia, hiperkalemia dan hiponatremia memengaruhi lama kesintasan.

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Background: The severity of Coronavirus Disease year 2019 (COVID-19) varies from mild to critical. Critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation have a high mortality rate. Research that focuses on the survival time of critically ill COVID-19 patients receiving mechanical ventilationhas not been carried out especially in Indonesia.

Methods: This retrospective survival cohort analysis observed critically ill COVID-19 patients receiving mechanical ventilation treated at a national respiratory center in Jakarta, Indonesia, between March and September 2020. Sampling was carried out by consecutive sampling and data of subjects who met the study criteria were obtained from medical records.

Results: Among 70 subjects, 51 subjects had complete medical records and met the study criteria. Subjects were predominately male (58.8%), mean age 55.98+11.96 years and median BMI 23.9 (IQR17-54) kg/m2. The median duration of mechanical ventilation was 4 (IQR 1-20) days with a survival rate of 7.8%. The median PaO2/FiO2 ratio was 72 (IQR 31-606)as the most of the subjects suffered from severe ARDS (84.3%). The median survival of critically ill COVID-19 patients with mechanical ventilation was 4 days (95%CI;3.139-4.861) and the mean survival was 5.5 days (95%CI;4.213-6.922). The median survival of subjects with severe ARDS was 4 days (95% CI;3.223-4.777). Median survival of subjects without severe ARDS was 6 days (95%CI; 2.799-9.201) with HR=0.802 (95%CI;0.337-1.911, p=0.619). The median survival of subjects with hypercapnia was 2 days (95%CI;0.00-4.006) with HR=0.613 (95%CI;0.3030-1.242, p=0.174). Median survival of subjects with hyponatremia was 3 days (95%CI;2.157-3.843) with HR=0.897 (95%CI; 0.5-1.610, p=0.716). Median survival of subjects with hyperkalemia was 2 days (95%CI;2.0-2.0) with HR=0.293 (95% CI; 0.061-1.419, p=0.127).

Conclusion: The survival rate for critically ill COVID-19 patients with mechanical ventilation at the start of the pandemic was low with a survival period of 4 days. The severity of ARDS before intubation, hypercapnia, hyperkalemia and hyponatremia influence the survival rate."

"Ventilator-associated pneumonia VAP punya prevalensi yang tinggi pada pasien pediatric intensive care unit PICU . Gizi lebih overweight dan obesitas dicurigai sebagai salah satu faktor risiko VAP namun hubungannya kurang diteliti. Penelitian ini bertujuan untuk menyelidiki hubungan antara gizi lebih dan kejadian VAP pada pasien PICU RSCM. Desain studi ini adalah cross-sectional analitik dengan data rekam medis pasien PICU RSCM yang mendapat ventilasi mekanik pada periode 2014 ndash;2016. Pasien dikatakan menderita gizi lebih berdasarkan assessment gizi pada rekam medis atau berdasarkan data antropometri dengan rujukan kriteria WHO atau CDC jika assessment gizi tidak ada. VAP ditentukan berdasarkan diagnosis tertulis pada rekam medis atau adanya gejala dan tanda yang memenuhi kriteria NNIS/CDC. Data tambahan yang diambil antara lain ada tidaknya kondisi immunocompromised, reintubasi, enteral feeding, penggunaan imunosupresan, antibiotik atau profilaksis stress ulcer. Sebanyak 64 pasien diikutsertakan sebagai subjek. Gizi lebih ditemukan pada 12 pasien 18.8 dan VAP pada 12 pasien 18.8 . Hanya satu pasien dengan gizi lebih mengalami VAP. Penelitian ini tidak menemukan hubungan antara gizi lebih dan kejadian VAP pada pasien PICU RSCM two-sided p = 0.436 dengan uji Fisher , mungkin karena sampel terlalu kecil. Penelitian prospektif dengan sampel yang cukup dibutuhkan untuk mengetahui hubungan antara gizi lebih dan VAP.

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Ventilator associated pneumonia VAP is prevalent among pediatric intensive care unit PICU patients. Overnutrition overweight and obesity is a candidate for VAP risk factor but research into the link is wanting. This study aimed to investigate the association between overnutrition and VAP among PICU patients in RSCM. Medical records of RSCM PICU patients undergoing mechanical ventilation between 2014 and 2016 were used in this analytic cross sectional study. Overnutrition was established based on the nutritional assessment on the patient rsquo s medical record or anthropometric data using WHO or CDC criteria if the former was not available. VAP was established based on recorded diagnosis or the presence of signs and symptoms meeting the NNIS CDC criteria. Additional data include whether the patient was immunocompromised, reintubation, enteral feeding, use of immunosuppressants, antibiotics and stress ulcer prophylaxis. A total of 64 patients was included as subjects. Overnutrition was identified in 12 patients 18.8 and VAP in 12 patients 18.8 . Only one overnourished patient had VAP. This study found no association between overnutrition and VAP two sided p 0.436 by Fisher rsquo s test , probably because the sample was too small. Prospective studies with adequate sample sizes are needed to understand the link between overnutrition and VAP."