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"Latar Belakang: Anemia atau kadar hemoglobin yang menurun dari nilai normalnya merupakan permasalahan yang biasa terjadi pada pasien kritis di Intensive Care Unit (ICU) dan 61% pasien anemia membutuhkan ventilasi mekanik. Anemia dapat mengganggu kemampuan ventilasi selama proses penyapihan dan ekstubasi. Namun pengaruh dari kadar hemoglobin yang menurun ini masih belum jelas dan diperdebatkan oleh karena itu telaah sistematis ini dibuat untuk mengambil kesimpulan apakah kadar hemoglobin berpengaruh terhadap proses penyapihan dan ekstubasi pada pasien kritis dengan ventilasi mekanik berdasarkan penelitian-penelitian yang tersedia.Tujuan: Mengetahui efek kadar hemoglobin terhadap proses penyapihan dan ekstubasi pada pasien kritis dengan ventilasi mekanik.Metode: Dengan menggunakan kata kunci spesifik, dilakukan pencarian artikel potensial secara komprehensif pada PubMed, EMBASE, Scopus dan Cochrane database dengan pembatasan waktu 2013 sampai dengan 2022. Protokol studi ini telah di registrasi di PROSPERO (CRD42022336646) pada tanggal 7 Agustus 2022.Hasil: Total 7 penelitian dengan 2.054 pasien dengan ventilasi mekanik memenuhi kriteria untuk penelitian ini dan dimasukkan dalam tinjauan sistematis. Setelah pemeriksaan database menyeluruh, dilaposkan satu studi tidak menemukan korelasi antara hemoglobin dan keberhasilan proses penyapihan dan ekstubasi. Enam penelitian menyatakan bahwa kadar hemoglobin berhubungan dengan keberhasilan proses penyapihan dan ekstubasi pada pasien sakit kritis dengan ventilasi mekanik. Penelitian ini menyimpulkan bahwa kadar hemoglobin mempengaruhi proses penyapihan dan ekstubasi pada pasien sakit kritis dengan ventilasi mekanik. Namun, diperlukan lebih banyak penelitian untuk mengkonfirmasi hasil tinjauan sistematis ini.Kesimpulan: Penelitian ini menyimpulkan kadar hemoglobin mempengaruhi proses penyapihan dan ekstubasi pada pasien kritis dengan ventilasi mekanik. Namun dibutuhkan penelitian yang lebih banyak untuk mengkonfirmasi hasil telaah sistematis ini.

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Background: Anemia or hemoglobin levels that decrease from average values ​​is a common problem in critical Intensive Care Unit (ICU) patients, and 61% of anemic patients require mechanical ventilation. Anemia can impair ventilation ability during weaning and extubation. However, the effect of decreased hemoglobin levels is still unclear and debated; therefore, this systematic review was made to conclude whether hemoglobin levels affect weaning and extubation processes in critically ill patients with mechanical ventilation based on available studies.

Objective: To determine the effect of hemoglobin levels on the process of weaning and extubation in critically ill patients with mechanical ventilation.

Methods: Using specific keywords, a comprehensive search of potential articles was carried out on PubMed, EMBASE, Scopus, and Cochrane databases with a time limit of 2013 to 2022. This study protocol was registered at PROSPERO (CRD42022336646) ) on August 7th, 2022.

Result: A total of 7 studies with 2,054 patients with mechanical ventilation met the criteria for this study and were included in a systematic review after a thorough database check. One study found no correlation between hemoglobin and the successful weaning and extubation process. Six studies stated that hemoglobin levels were associated with the success of the weaning and extubation process in critically ill patients with mechanical ventilation.

Conclusion: This study concludes that hemoglobin levels influence the weaning and extubation processes in critically ill patients with mechanical ventilation. However, more research is needed to confirm the results of this systematic review."

"Latar Belakang: Ventilasi mekanik merupakan salah satu prosedur yang sering digunakan dalam penatalaksanaan pasien sakit kritis yang mengalami gagal napas. Penggunaan ventilator jangka panjang (Prolonged Mechanical Ventilation, PMV) meningkatkan morbiditas dan mortalitas. Salah satu faktor risiko yang berperan dalam terjadinya PMV adalah malnutrisi dan sarkopenia, yang ditandai dengan hilangnya massa dan fungsi otot. Di satu sisi, sakit kritis sendiri ditandai dengan hipermetabolisme dan peningkatan katabolisme protein otot itu sendiri. Pemantauan massa otot di perawatan intensif menjadi penting, namun belum ada metode pengukuran yang cukup praktis dalam menggambarkan massa otot tubuh. Creatinine Height Index dapat menjadi salah satu penanda massa otot tubuh sehingga diperkirakan terdapat perbedaan perubahan Creatinine Height Index terhadap keberhasilan penyapihan pada pasien dengan penggunaan ventilator jangka panjang. Metode: Penelitian ini merupakan studi prospektif observasional pada pasien sakit dengan PMV di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Dilakukan pengukuran Creatinine Height Index (CHI) pada 72 jam pertama pemakaian intubasi dan diulang pada saat pasien ekstubasi atau maksimal hari ke-14 penggunaan ventilator. Hasil Creatinine Height Index akan dilihat berdasarkan keberhasilan penyapihan. Karakteristik subjek lainnya meliputi usia, jenis kelamin, riwayat asupan bahan makanan sumber kreatin, aktivitas fisik pra admisi, imbang cairan kumulatif, asupan energi dan protein selama perawatan di ICU. Hasil: Terdapat 27 subjek dengan rerata usia 46 tahun dan mayoritas laki-laki (67%). Nilai CHI awal dan akhir tidak berbeda pada kelompok yang berhasil maupun yang gagal menyapih (p = 0,466 dan p = 0,494), namun nilai perubahan CHI berbeda bermakna secara statistik pada mereka yang mengalami berhasil menyapih dan gagal menyapih (p= 0,009). Kelompok yang gagal menyapih mengalami penurunan nilai CHI sebesar 3,9 (-18,3;23,7)%. Kesimpulan: Tidak terdapat perbedaan bermakna pada nilai CHI awal maupun akhir pada kelompok yang berhasil dan gagal menyapih. Terdapat perbedaan bermakna secara statistik pada perubahan nilai CHI pada kelompok yang berhasil dan gagal menyapih. Kelompok yang gagal menyapih mengalami penurunan nilai CHI, sementara kelompok yang berhasil menyapih tidak mengalami hal tersebut

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Background: Mechanical ventilation is one of the procedures that frequently used in the management of critically ill patients experiencing respiratory failure. Prolonged mechanical ventilation increases morbidity and mortality. One of the risk factors contributing to prolonged mechanical ventilation (PMV) is malnutrition and sarcopenia, characterized by loss of muscle mass and its function. On one hand, critical illness itself is marked by hypermetabolism and increased muscle protein catabolism. Monitoring muscle mass in intensive care is essential, but there is currently no practical method for describing whole-body muscle mass. Creatinine Height Index could serve as an indicator of body muscle mass, suggesting potential differences between Creatinine Height Index level changes and successful weaning in patients with prolonged mechanical ventilation. Methods: This study is a prospective observational study conducted on critically ill patients with prolonged mechanical ventilation (PMV) at RSUPN dr. Cipto Mangunkusumo and RS Universitas Indonesia. Creatinine Height Index (CHI) was measured within the first 72 hours of intubation and repeated upon extubation or by day 14 of ventilation. CHI results were then categorized based on weaning success. Other subject characteristics included age, gender, history of dietary creatine intake, pre-admission physical activity, cumulative fluid balance, energy intake, and protein intake during ICU hospitalization. Results: There were 27 subjects with a mean age of 46 years, predominantly male (67%). Initial and final CHI values did not differ between the successful and failed weaning groups (p = 0.466 and p = 0.494, respectively), but there was a statistically significant difference in the change in CHI values between those who successfully weaned and those failed (p = 0.009). The failed weaning group experienced a decrease in CHI values by 3.9 (-18.3; 23.7)%. Conclusion: There was no significant difference in initial or final CHI values between the groups that successfully weaned and those who failed. However, there was a statistically significant difference in the CHI values alteration between those groups. The failed weaning group experienced a decrease in CHI values, while the successful weaning group did not."

"Sakit kritis merupakan suatu kondisi terjadinya gangguan fungsi multiorgan yang menyebabkan homeostasis tubuh tidak dapat dipertahankan tanpa adanya intervensi medis di unit perawatan intensif. Proses hiperkatabolik akibat stres metabolik pada pasien sakit kritis terutama di fase akut sangat tinggi sehingga menyebabkan degradasi protein. Tingkat degradasi ini dapat dilihat salah satunya dengan pemeriksaan kehilangan nitrogen melalui urin 24 jam. Asupan energi dan protein berperan penting dalam memelihara proses metabolisme yang terjadi. Asupan yang tidak adekuat diiringi kehilangan protein yang tinggi akan menghasilkan nilai imbang nitrogen yang negatif. Tujuan penelitian ini untuk melihat korelasi asupan protein selama fase akut terhadap perubahan imbang nitrogen yang dinilai pada hari ke-3 dan ke-7 perawatan. Metode penelitian ini menggunakan desain potong lintang yang dilakukan di Intensive Care Unit Rumah Sakit Universitas Indonesia (ICU RSUI) dengan pengambilan sampel secara consecutive sampling. Kriteria penerimaan adalah berusia 18-60 tahun, mendapatkan asupan protein pertama dalam 48 jam, dan bersedia mengikuti penelitian. Kriteria penolakan adalah produksi urin <0.5 ml/kgBB/jam, gangguan fungsi ginjal dan hati kronis, IMT <18.5 atau ≥30 kg/m², skor APACHE II>30, hamil, dan mendapat norepinefrin >0.3 mcg. Kriteria pengeluaran adalah mendapatkan rerata asupan protein hari ke-3 hingga ke-7 <0.5gr/kgBB/hari, dan meninggal sebelum hari ke-7. Pemeriksaan kadar nitrogen urea urin 24 jam dan perhitungan imbang nitrogen dinilai pada hari ke-3 dan ke-7 perawatan. Hasil penelitian menunjukkan rerata asupan protein dan energi pada 21 subyek adalah 0.8 gr/kgBB/hari dan 78% dari EE pada hari ke-3, lalu rerata asupan pada hari ke-7 adalah 1.1 gr/kgBB/hari dan 110% dari EE. Rerata kadar NUU dan imbang nitrogen hari ke-3 adalah 8.1 gr dan -5.3 gr. Rerata kadar NUU dan imbang nitrogen hari ke-7 adalah 7.2 gr dan -1.5 gr. Rerata perubahan imbang nitrogen bernilai positif yaitu 3.8 gr. Terdapat korelasi positif antara asupan energi maupun protein terhadap imbang nitrogen hari ke-3 (r=0.5, p=0.01; r=0.6, p=0.003). Walaupun terdapat perbaikan imbang nitrogen yang signifikan pada subyek penelitian namun tidak didapatkan korelasi bermakna antara asupan protein terhadap perubahan imbang nitrogen (p=0.1). Kesimpulan penelitian ini adalah asupan energi dan protein berkorelasi positif dengan imbang nitrogen pada early acute phase. Asupan protein pada late acute phase tidak berhubungan dengan perubahan imbang nitrogen pada penelitian ini

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Critical illness is a condition where multiorgan dysfunction occurs which causes body homeostasis that cannot be maintained without medical intervention in the intensive care unit. The hypercatabolic process due to metabolic stress in critically ill patients, especially in the acute phase, is very high, causing protein degradation. This level of degradation can be evaluated by examining nitrogen loss through 24-hour urine. Energy and protein intake plays an important role in maintaining the metabolic processes. Inadequate intake accompanied by high protein losses will result in negative nitrogen balance values. The aim of this study was to analyze the correlation of protein intake during the acute phase with nitrogen balance changes on days 3 and 7 of treatment. The method of this study was cross-sectional with consecutive sampling, conducted in the Intensive Care Unit of the University of Indonesia Hospital (ICU RSUI). Inclusion criteria were 18-60 years old, getting their first protein intake within 48 hours, and willing to take part in the research. Exclusion criteria were urine output <0.5 ml/kgBW/hour, chronic kidney and liver function disorders, BMI <18.5 or ≥30 kg/m2, APACHE II score>30, pregnancy, and receiving norepinephrine >0.3 mcg. Drop out criteria were patients having an average protein intake on days 3 to 7 <0.5 gr/kgBW/day, or dying before the 7^th day. Examination of 24-hour urine urea nitrogen (UUN) levels and calculation of nitrogen balance were assessed on days 3 and 7 of treatment. The results of the study showed that the mean of protein and energy intake in the 21 subjects was 0.8 gr/kgBW/day and 78% of EE on day 3, then the mean intake on day 7 was 1.1 gr/kgBW/day and 110% of EE. The mean ​​of UUN levels and nitrogen balance on day 3 were 8.1 gr and -5.3 gr. The mean of UUN levels and nitrogen balance on day 7 were 7.2 gr and -1.5 gr. Mean of nitrogen balance changes was positive, namely 3.8 gr. There was a positive correlation between energy and protein intake with nitrogen balance on day 3 (r=0.5, p=0.01; r=0.6, p=0.003). Although there was a significant improvement in nitrogen balance in the research subjects, there was no significant correlation between protein intake with nitrogen balance changes (p=0.1). The conclusion of this study is that energy and protein intake were positively correlated with nitrogen balance in the early acute phase. Protein intake in the late acute phase was not associated with nitrogen balance changes in this study."

"[ABSTRAKLatar Belakang. Penilaian derajat kesadaran penting dilakukan pada pasien di Unit Gawat Darurat untuk memperkirakan prognosis. Banyak sistem penilaian dipakai untuk mengevaluasi pasien, masing-masing dengan kelebihan dan kekurangannya. Sistem penilaian yang baru, yaitu Full Outline of Unresponsiveness (FOUR )Score, dapat digunakan menilai derajat kesadaran dan memprediksi prognosis pasien. FOUR Score dapat memberikan data neurologis yang lebih detail dan dapat digunakan pada pasien yang terintubasi. Belum ada penelitian yang menilai validitas FOUR Score sebagai prediktor outcome pada pasien dengan penurunan kesadaran di IGD RSCM sebelumnya.Metode. Penelitian kohort prospektif observasional pada pasien dengan penurunan kesadaran yang dirawat di IGD RSCM. Evaluasi FOUR Score dilakukan terhadap 120 pasien baru yang dirawat di IGD RSCM. Outcome pasien dicatat setelah perawatan 72 jam. Analisis bivariat digunakan untuk menentukan hubungan FOUR Score terhadap outcome. Analisis regresi logistik untuk menentukan hubungan komponen FOUR Score terhadap outcome. Nilai area di bawah kurva (AUC) digunakan untuk sebagai uji dsikriminasi FOUR Score terhadap outcome.Hasil. Terdapat hubungan yang bermakna antara nilai FOUR Score dengan outcome (p <0,001). Komponen respon membuka mata (FOUR-E) dan pola respirasi (FOUR-R) adalah komponen yang mempunyai nilai prediksi terhadap outcome. AUC FOUR Score adalah 0,864 (95% IK 0,784-0,928).Uji kesesuaian antarpenilai antara dokter dan perawat menunjukkan kesesuaian yang sangat baik dengan κ = 0,836 (95% IK 0,786- 0,894), p <0,001.

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ABSTRACTBackground. Asssessment of conciousness is important in patients in emergency room to estimate prognosis. Many scoring systems used to evaluate patients? level of conciousness, each with their advantages and disadvantages Full Outline of Unresponsiveness (FOUR) Score is a new system to assess patients?s level of conciousness and future prognosis. FOUR Score can provide a detailed neurological data and can be used in patients who are intubated. There have never been done a research on validity of FOUR Score as a predictor of outcome in RSCM?s ER before.Method. Observational, prospective cohort study in patients with decreased of conciousness treated in the RSCM?s ER. FOUR Score?s evaluation conducted on 120 new patients. Patient?s outcome was recorded after 72 hours of treatment, and classified as dead or alive. Bivariate analysis conducted to determine the relation between FOUR Score and outcome. Logistic regression analysis was performed to determine the relation between components of the FOUR Score and the outcome, and the value of area under the curve (AUC) of the FOUR Score to outcome was determined to measure discrimination of FOUR Score.Results. There is a significant correlation statistically between the value of the FOUR Score with the outcome (p <0.001). From all the components had been measured, the eye response (FOUR-E) and respiratory pattern (FOUR-R) had predictive value related to the outcome. AUC of the FOUR Score is 0,864 (95% CI 0,784-0,928). Inter-rater agreement between doctor and nurse shows a very good strength of agreement wtith κ = 0,836 (95% CI 0,786- 0,894), p <0,001.Conclusion. FOUR Score can accurately predict the outcome of patients with decreased of consciousness in the RSCM?s ER after 72 hours of treatment.;Background. Asssessment of conciousness is important in patients in emergency room to estimate prognosis. Many scoring systems used to evaluate patients? level of conciousness, each with their advantages and disadvantages Full Outline of Unresponsiveness (FOUR) Score is a new system to assess patients?s level of conciousness and future prognosis. FOUR Score can provide a detailed neurological data and can be used in patients who are intubated. There have never been done a research on validity of FOUR Score as a predictor of outcome in RSCM?s ER before.Method. Observational, prospective cohort study in patients with decreased of conciousness treated in the RSCM?s ER. FOUR Score?s evaluation conducted on 120 new patients. Patient?s outcome was recorded after 72 hours of treatment, and classified as dead or alive. Bivariate analysis conducted to determine the relation between FOUR Score and outcome. Logistic regression analysis was performed to determine the relation between components of the FOUR Score and the outcome, and the value of area under the curve (AUC) of the FOUR Score to outcome was determined to measure discrimination of FOUR Score.Results. There is a significant correlation statistically between the value of the FOUR Score with the outcome (p <0.001). From all the components had been measured, the eye response (FOUR-E) and respiratory pattern (FOUR-R) had predictive value related to the outcome. AUC of the FOUR Score is 0,864 (95% CI 0,784-0,928). Inter-rater agreement between doctor and nurse shows a very good strength of agreement wtith κ = 0,836 (95% CI 0,786- 0,894), p <0,001.Conclusion. FOUR Score can accurately predict the outcome of patients with decreased of consciousness in the RSCM?s ER after 72 hours of treatment., Background. Asssessment of conciousness is important in patients in emergency room to estimate prognosis. Many scoring systems used to evaluate patients? level of conciousness, each with their advantages and disadvantages Full Outline of Unresponsiveness (FOUR) Score is a new system to assess patients?s level of conciousness and future prognosis. FOUR Score can provide a detailed neurological data and can be used in patients who are intubated. There have never been done a research on validity of FOUR Score as a predictor of outcome in RSCM?s ER before.Method. Observational, prospective cohort study in patients with decreased of conciousness treated in the RSCM?s ER. FOUR Score?s evaluation conducted on 120 new patients. Patient?s outcome was recorded after 72 hours of treatment, and classified as dead or alive. Bivariate analysis conducted to determine the relation between FOUR Score and outcome. Logistic regression analysis was performed to determine the relation between components of the FOUR Score and the outcome, and the value of area under the curve (AUC) of the FOUR Score to outcome was determined to measure discrimination of FOUR Score.Results. There is a significant correlation statistically between the value of the FOUR Score with the outcome (p <0.001). From all the components had been measured, the eye response (FOUR-E) and respiratory pattern (FOUR-R) had predictive value related to the outcome. AUC of the FOUR Score is 0,864 (95% CI 0,784-0,928). Inter-rater agreement between doctor and nurse shows a very good strength of agreement wtith κ = 0,836 (95% CI 0,786- 0,894), p <0,001.Conclusion. FOUR Score can accurately predict the outcome of patients with decreased of consciousness in the RSCM?s ER after 72 hours of treatment.]"

"Pendahuluan: Berbagai studi menyatakan bahwa pencapaian kadar terapeutik vankomisin pada pasien sakit kritis sangat rendah. Hal ini terjadi karena perubahan farmakokinetik pada pasien kritis akibat proses penyakit dan berbagai intervensi medis. Vankomisin mempunyai indeks terapeutik yang sempit, oleh karena itu pencapaian target kadar terapeutik sangat penting dievaluasi. Saat ini, pemberian vankomisin pada pasien sakit kritis di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia berdasarkan pedoman penggunaan antibiotik tahun 2022. Namun, evaluasi pencapaian target kadar terapeutik vankomisin pada pasien kritis belum pernah dilakukan. Evaluasi pencapaian target kadar terapeutik vankomisin ini dapat menjadi bahan pertimbangan untuk membuat pedoman pemberian dosis vankomisin yang lebih adekuat. Penelitian ini bertujuan untuk mengetahui gambaran pencapaian kadar terapeutik vankomisin pada pasien sakit kritis. Metode: Penelitian ini merupakan studi pendahuluan dengan desain potong lintang. Rekrutmen subjek penelitian dilakukan dengan metode consecutive sampling. Subjek penelitian adalah pasien sakit kritis yang menggunakan vankomisin. Pemeriksaan kadar vankomisin dilakukan dengan metode ELISA pada sampel darah subjek yang diambil saat trough concentration. Data-data klinis dan laboratorium lain didapatkan dari rekam medis subjek. Hasil: Jumlah subjek penelitian ini adalah 20 orang. Target kadar terapeutik vankomisin tercapai pada 45% subyek penelitian. Median kadar vankomisin pada penelitian ini adalah 17,43 mg/L (3,07 – 25,11 mg/L). Kadar terapeutik vankomisin lebih banyak tercapai pada subyek yang tidak mengalami overload cairan (61,5%) dan yang mendapat vankomisin dengan cara infus yang diperpanjang (64,3%). Pada penelitian didapatkan 3 (15,8%) subyek mengalami cidera ginjal akut setelah penggunaan vankomisin, dengan kadar vankomisin 17,37 mg/L, 11,16 mg/L, dan 13,64 mg/L. Kesimpulan: Capaian target kadar terapeutik vankomisin terjadi hanya pada sebagian pasien sakit kritis. Keadaan subyek yang tidak overload cairan dan pemberian infus vankomisin yang diperpanjang menjadi faktor yang mungkin mempengaruhi tercapainya target kadar terapeutik vankomisin. Kata kunci: trough concentration, vankomisin, pasien sakit kritis, farmakokinetik, kadar terapeutik

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Introduction: Various studies have stated that the achievement of vancomycin therapeutic levels in critically ill patients is very low. This condition occurs because of pharmacokinetic changes in critically ill patients due to the disease process and various medical interventions. Vancomycin has a narrow therapeutic index, therefore it is important to evaluate the drug concentration. Currently, the administration of vancomycin in critically ill patients at Cipto Mangunkusumo Hospital, Jakarta, Indonesia is based on local antibiotic guidelines 2022. However, an evaluation of vancomycin concentration in critically ill patients has never been carried out. Evaluation of vancomycin concentration can be considered as a basis for making adequate vancomycin dosing guidelines. Aim of this study was to describe the vancomycin concentration in critically ill patients. Methods: This research is a preliminary study with a cross-sectional design. Subjects recruitment was done by consecutive sampling method. Subjects were critically ill patients who taking vancomycin. Examination of vancomycin concentration was conducted using ELISA method on subjects' blood samples taken during trough concentration. Other clinical and laboratory data were obtained from the subject's medical record. Result: Sample size of this study was 20 subjects. The target therapeutic level of vancomycin was achieved in 45% of the study subjects. The median of vancomycin concentration on this study was 17.43 mg/L (3.07 – 25.11 mg/L). Therapeutic levels of vancomycin were achieved more in subjects who did not experience fluid overload (61.5%) and received vancomycin by extended infusion method (64.3%). There were 3 subjects (15.8%) experienced acute kidney injury after using vancomycin, with vancomycin concentration of 17.37 mg/L, 11.16 mg/L, and 13.64 mg/L. Conclusion: Achievement of target therapeutic levels of vancomycin occurs in only a minority of critically ill patients. The condition of the subjects who are not fluid overload and the prolonged administration of vancomycin infusion are factors that may affect the achievement of the target therapeutic level of vancomycin. Keywords: trough concentration, vancomycin, critically ill patients, pharmacokinetics, therapeutic concentration"

"This textbook approaches the study of critical care with teaching in mind. In medicine teachable moments usually occur in clinical context, where the engagement in a real case exemplifies principles of diagnosis or therapy. In order to replicate the teaching method, selected cases are presented within each chapter offering the reader an opportunity to process and reflect on the components of the topic within a practical scenario. While medical practice attempts to be evidence-based, common approaches to diagnosis and management incorporate not only evidence but heuristics and biases which await either validation or repudiation. Hence, each chapter is divided into two segments: the Principles of Management section - the common approach to the care of patients having a given condition is presented - and the Evidence Contour section, in which each author discusses the aspects of diagnosis and management that are the subject of ongoing debate."

"Dalam konteks perawatan ICU, ada beberapa masalah utama yang perlu ditangani untuk mengoptimalkan penggunaan sumber daya dan outcome pasien. Fasilitas ICU di Indonesia terutama di lingkungan dengan sumber daya terbatas, masih kewalahan memenuhi kebutuhan perawatan intensif untuk kondisi akut yang menjadi prioritas pelayanan ketimbang memikirkan atau menerapkan strategi perawatan berdasarkan kedokteran presisi yang kompleks. "

"ABSTRAKPneumonia merupakan peradangan pada parenkim paru yang sering terjadi pada masaanak-anak dan masa bayi. Peradangan tersebut menyebabkan sputum terkumpul diparu, yang membuat sulit untuk bernafas. Salah satu cara untuk mengeluarkansputum adalah CPT. Tujuan dari penelitian ini adalah untuk mengetahui pengaruhchest physiotherapy (CPT) terhadap status pernafasan anak balita pnemonia. Desainpenilitan ini menggunakan quasi eksperiment post test only dengan grup kontrol.Hasil penelitian menunjukkan bahwa ada pengaruh CPT terhadap suara nafas (pvalue= 0,008), retraksi dada (p value= 0,008), frekuensi pernafasan (p value= 0,001)dan saturasi oksigen (p value= 0,01) pada balita. Penelitian ini merekomendasikanCPT sebagai intervensi keperawatan untuk memperbaiki status pernafasan anak.

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ABSTRACTPneumonia is an inflammantory condition of the lung. Child and infant included agroup that have risk to get pneumoni. The inflammantion causes pulmonary sputumcollection and this make difficult to breath. One of the ways to take out the sputum isby doing chest physiotherapy (CPT). The purpose of this research was to find out theeffect of chest physiotherapy (CPT) toward respiratory status of children pnemonia.Design of this study used quasi eksperiment post test only non equivalent group. Theresult of the study showed there was significant effect of CPT againts breath sounds(p value= 0,008), chest retraction (p value= 0,008), respiratory rate (p value= 0,001)and oxygen saturation (p value= 0,010) on children. This research recommend CPTas a nursing intervention to recover children respiratory status."

"Pasien yang dirawat diruang perawatan intensif banyak terpasang alat-alat invasif yang dapat membuat pasien merasa tidak nyaman, nyeri dan kadang gelisah. Kolaborasi pemberian sedasi merupakan salah satu intervensi yang dapat memberikan rasa nyaman. Perawat berperan penting dalam pemantauan sedasi sehingga perlu paham terkait manajemen sedasi di ruang rawat intensif. Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan perawat dengan praktik pemberian sedasi di ruang intensif di salah satu rumah sakit rumah sakit tipe A di Jakarta. Metode yang digunakan adalah cross sectional study dengan 80 responden, alat ukur yang digunakan adalah Nurses Knowledge of Sedatives, Sedation Assessment and Management Questionnaire dan Nurses Sedation Practice Scale Questionnaire. Hasil analisis one way anova menunjukkan bahwa terdapat perbedaan yang signifikan pada rata-rata praktik pemberian sedasi oleh perawat menurut tingkat pengetahuan perawat dengan p Value = 0,000. Penelitian ini merekomendasikan bahwa peningkatan pengetahuan perawat dapat dilakukan melalui program pendidikan dan pelatihan yang bertujuan untuk meningkatkan pengetahuan terkait pengkajian dan manajemen sedasi.

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Patients who are treated in intensive care unit are predominantly equipped by invasive devices which initiate discomfort, pain and restlessness to the patients. Collaboration in offering sedation is one of the intervention that can provide a feeling of comfort. Nurses play an important role in monitoring sedation hence they need to understand the sedation management in the intensive care unit. This study aimed to determine the correlation of nurses' knowledge with the practice of providing sedation in the intensive care unit in a type A hospital in Jakarta. The research methodology used a cross sectional study with 80 respondents and used the Nurses Knowledge of Sedatives, Sedation Assessment and Management Questionnaire and Nurses Sedation Practice Scale Questionnaire. The results of the one way anova analysis showed that there was a significant difference in the average sedation practice by nurses according to the level of knowledge of nurses with p Value = 0.000. This study recommends that increasing the knowledge of nurses can be done through education and training programs that aims to increase the knowledge related to sedation assessments and managements."