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"Tujuan: Melakukan telaah sistematis untuk membandingkan terapi hidrokortison dan hidrokortison, asam askorbat, dan tiamin (HAT) sebagai ajuvan pada tingkat mortalitas pasien syok septik. Metode: Pencarian komprehensif dilakukan menggunakan empat pangkalan data (PubMed, EMBASE, Scopus, and Cochrane) menggunakan kata kunci spesifik hingga tanggal 18 Mei 2022. Semua studi yang dipublikasikan mengenai penggunaan terapi HAT pada pasien syok septik dikumpulkan dan ditelaah. Hasil: Dua studi uji acak terkendali, satu studi kontrol kasus, dan satu studi kohort yang melibatkan 635 pasien. Terapi HAT ditemukan tidak signifikan dalam menurunkan angka kematian di ICU (RR 0.89 95% CI [0.60 sampai 1.32], p=0.56), angka kematian di rumah sakit (RR 1.2 95% CI [0 ,90 sampai 1.59], p= 0,21), dan mortalitas 28 hari (RR 0,95, 95% CI [0,56 hingga 1,58], p=0,83) Kesimpulan: Tidak ditemukan perbedaan signifikan dalam mortalitas pada kelompok yang menggunakan HAT bila dibandingkan dengan terapi hidrokortison. Registrasi: ID pendaftaran PROSPERO untuk penelitian ini adalah CRD42022296055 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296055).

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Objective: We systematically reviewed the comparison between hydrocortisone and hydrocortisone-ascorbic acid-thiamine combined therapy (HAT) as adjuvant in the mortality rate of septic shock patients. Method: Four databases (PubMed, EMBASE, Scopus, and Cochrane) are comprehensively searched using specific keywords up to 18th May 2022. All published studies on the use of HAT on septic shock patients were collected and reviewed Results: Two randomized controlled trials, one case control study and one cohort study enrolling 635 patients were included. HAT therapy was found to be not significant in reducing the ICU mortality rate (RR 0,89 95% CI [0,60 to 1,32], p=0,56), hospital mortality rate (RR 1.2 95% CI [0,90 to 1,59], p=0,21), and 28 days mortality (RR 0,95, 95% CI [0,56 to 1,58], p=0,83). Conclusion: No significant difference in mortality was found in the HAT group when compared with hydrocortisone therapy. Trial registration: PROSPERO registration ID for this study is CRD42022296055 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296055)."

"Latar belakang: Syok septik merupakan kondisi klinis umum yang terkait dengan tingkat kematian yang tinggi diantara pasien sakit kritis. Pasien syok sangat memerlukan pemantauan ketat terhadap tanda-tanda klinis serta status hemodinamik dan status intravaskuler. Perawat intensif memiliki peran penting untuk pengenalan dini sepsis dan identifikasi perburukan, sehingga perawat intensif perlu memiliki pengetahuan dan sikap yang baik dalam penanganan syok septik. Tujuan penelitian: menganalisis hubungan antara tingkat pengetahuan dengan sikap perawat intensif dalam penanganan pasien syok septik di Intensive Care Unit RS Grup X Jakarta. Desain penelitian menggunakan deskriptif analitik korelasi dengan pendekatan cross sectional, analisis penelitian dengan uji Fisher Exact pada 110 responden perawat intensif dilakukan di 3 RS pada Grup X Jakarta. Pengumpulan data dengan menggunakan kuesioner. Kesimpulan: ada hubungan signifikan antara tingkat pengetahuan dengan sikap perawat intensif dalam penanganan pasien syok septik di RS Grup X Jakarta (p-value 0.044 < α= 0.05). Rekomendasi: Pengetahuan perawat dalam mengidentifikasi dan melakukan tatalaksana syok septik, serta skrining pencegahan syok septik (qSOFA dan SOFA) harus ditingkatkan dalam bentuk peningkatan pengetahuan terstruktur.

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Septic shock is common clinical condition associated with high mortality rate among critically ill patients. Septic shock patient should be closed monitoring of clinical signs and hemodynamic also intravascular status. Intensive nurses have an important role for early identify and prevent septic shock. So, critical nurses have to good knowledge and attitudes in management of septic shock. Aim: this study was to analyze the correlation knowledge level and nurse’s attitude of septic shock management in intensive care unit at Group X Hospital Jakarta. Study Design: descriptive analytic correlation with a cross-sectional using Fisher Exact test on 110 intensive nurse respondents at 3 Hospital of Group X Jakarta. Conclusion: there is a significant correlation between the level of knowledge and attitude intensive nurses in management of septic shock patients at Group X Hospital Jakarta (p < α = 0.05). Recommendation: Knowledge nurses to identify and management septic shock, screening to prevent septic shock (q-SOFA and SOFA) must be improved with knowledge structured improvement."

"ABSTRAKInflamasi sistemik pada renjatan sepsis dapat menyebabkan insufisiensi adrenal. Kadar asam lemak bebas ALB yang tinggi diketahui menyebabkan inflamasi steril dan menghambat adrenocorticothropic hormone dan sekresi kortisol. Pemberian hidrokortison pada renjatan sepsis diharapkan memperbaiki hemodinamik, menurunkan ketergantungan terhadap obat vasoaktif dan memperbaiki disfungsi organ.Penelitian bersifat studi eksperimental yang bertujuan menilai pengaruh ALB dan pemberian hidrokortison terhadap hemodinamik, kadar laktat, cedera paru dan kadar kortisol darah pada renjatan sepsis model anak babi. Penelitian dilaksanakan di Divisi Bedah dan Radiologi Departemen Klinik Reproduksi dan Patologi Fakultas Kedokteran Hewan Institut Pertanian Bogor FKH IPB pada April -September 2015 dan telah disetujui oleh Komisi Etik Hewan FKH IPB.Delapan model anak babi Sus scrofa berusia 6-8 minggu dengan berat 5-10 kg dibagi dalam 2 kelompok, yaitu kelompok lipid dan kelompok kontrol. Kelompok lipid diberi lipid 20 sebanyak 3 gram/kgbb intravena dan kelompok kontrol tanpa pemberian lipid sebelum induksi sepsis. Pengukuran parameter hemodinamik dengan Pulse Contour Cardiac Output PiCCO . Pengukuran kadar laktat dengan i-Stat. Cedera paru ditentukan dengan pengukuran extravascular lung water index EVLWI dan rontgen toraks. Tes synacthen dilakukan untuk mengetahui adanya insufisiensi adrenal relatif IAR .Pengaruh ALB terhadap hemodinamik dinilai dengan rerata cardiac index 60 menit setelah pemberian hidrokortison yang berbeda bermakna [2,14 0,06 l/menit/m2 vs. 2,75 0,04 l/menit/m2 p 0,002 ]. Jumlah cairan dan obat vasoaktif yang dibutuhkan kelompok lipid untuk mempertahankan mean arterial blood pressure > 65 mmHg lebih banyak dibandingkan kelompok kontrol. Kadar laktat meningkat sebelum induksi sepsis pada kelompok lipid [2,28 0,52 vs. 1,28 0,45 mmol/L p 0,001 ]. Bersihan laktat pada kelompok lipid lebih buruk dibandingkan kelompok kontrol. Extravascular lung water index kelompok lipid lebih tinggi bermakna dibanding kelompok kontrol setelah 60 menit resusitasi [21 4,04 mL/kg vs. 12,38 2,32 mL/kg p 0,004 ]. Gambaran radiologi efusi pleura dan edema pulmonal terjadi pada seluruh model anak babi kelompok lipid. Insufisiensi adrenal relatif terjadi pada 7 model anak babi di kelompok lipid dan 4 di kelompok kontrol.Kesimpulan penelitian ini adalah kadar ALB yang tinggi memperberat inflamasi dan merupakan faktor risiko terjadinya IAR. Kata kunci: Asam lemak bebas, cedera paru, hemodinamik, hidrokortison insufisiensi adrenal relatif, laktat, renjatan sepsis, sepsis.

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ABSTRACTCortisol deficiency is associated with increased morbidity and mortality during critical illness. Dysregulation of immune system in septic shock triggers adrenal insufficiency. Free fatty acid FFA is known to induced sterile inflammation and inhibit adrenocorticothropic hormone and cortisol secretion. Hydrocortisone administration is expected to improve hemodynamic, decrease dependency of vasoactive drugs and improve organ dysfunction in septic shock.The aim of this study is to find out the effect of FFA and hydrocortisone administration on hemodynamic parameters, lactate, lung injury and blood cortisol levels in septic shock piglet models, conducted in April September 2015 in the Division of Surgery and Radiology School of Veterinary Medicine, Institut Pertanian Bogor IPB and has been approved by the Animal Ethics Committee of School of Veterinary Medicine IPB. Sixteen piglet models Sus scrofa entered the study. The piglets were 6 8 weeks old, weighing 5 10 kg divided into two groups, lipids and control groups. Administration of 3 g kg BW of lipid 20 were performed intravenously before sepsis induction for lipid group. Hemodynamic measurement by Pulse Contour Cardiac Output PiCCO by Picco. Lactate measurement by i Stat. Lung injury was determined by Extravascular lung water index EVLWI and chest X ray. Synacthen test to determine relative adrenal insufficiency RAI .FFA influences was shown on cardiac index 60 min after adminstration of hydrocortisone in lipid group 2.14 0.06 L min m2 and control group 2.75 0.04 L min m2 p 0.002 . Lipid group require fluids and vasoactive drugs more than the control grup to maintain mean arterial blood pressure 65 mmHg. Lactate levels before induction of sepsis lipid group 2.28 0,52 mmol L and control group 1.28 0.45 mmol L p 0.001 . Lactate clearance in lipid group was worse than the control group. Extravascular lung water index at 60 minutes after resuscitation in lipid group 21 4.04 mL kg and control group 12.38 2.32 mL kg p 0.004 . Pleural effusion and pulmonary edema were found in all piglet models in lipid group. Relative adrenal insufficiency occured to 7 piglet model in lipid gorup and 4 in control group.Conclusion High level FFA aggravate inflammation in septic shock and is a risk factor for RAI. Hydrocortisone administration improve circulation and lactate levels. Keywords FFA, hemodynamic, hydrocortisone, lactate, lung injury, relative adrenal insufficiency, sepsis, septic shock"

"Sepsis merupakan suatu disfungsi organ yang bersifat mengancam jiwa yang disebabkan oleh infeksi, sedangkan syok septik adalah sekumpulan tanda-tanda sepsis dengan resiko mortalitas yang lebih tinggi. Penatalaksanaan pasien bergantung pada pemberian antibiotik empiris yang sesuai untuk mencegah resistensi bakteri terhadap antibiotik yang diberikan. Tujuan penelitian ini yaitu untuk melihat pola antibiotik yang diberikan kepada pasien sepsis dan menilai kesesuaian penggunaan antibiotik pada pasien sepsis di Instalasi Gawat Darurat RSUP Fatmawati periode Oktober-Desember 2016. Penelitian ini dilakukan dengan desain cross sectional dan bersifat deskriptif secara retrospektif dengan mengevaluasi catatan rekam medis dari 99 pasien sepsis. Pengambilan sampel penelitian dilakukan dengan teknik total sampling. Hasil analisis pada 99 pasien sepsis, didapatkan jumlah penderita laki-laki lebih tinggi daripada perempuan, yaitu sebesar 56.57 dan paling banyak diderita oleh pasien lansia akhir >55-65 tahun sebesar 34.34. Kriteria pasien sepsis didapatkan bahwa pasien sepsis sebesar 73.74 dan syok septik sebesar 26.26. Antibiotik tunggal yang paling sering digunakan adalah seftriakson, sedangkan antibiotik yang paling sering dikombinasi adalah levofloksasin seftriakson. Penggunaan antibiotik yang memenuhi kriteria tepat pasien sebanyak 49.49 , tepat indikasi sebanyak 70.71 , dan tepat dosis sebanyak 34.34.

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Sepsis is defined as life threatening organ dysfunction caused by infection, whereas septic shock is a subset of sepsis in which substantially increase mortality. The management of the patient depends on treating septic patient especially with appropriate empirical antibiotics to prevent bacterial resistance.

The purpose of this study was to perceive of the antibiotic prescription patterns given to sepsis patients and assess the accuracy of antibiotic usage in sepsis patients in the Emergency Department of Fatmawati Central General Hospital October to December 2016 period.

The design of this study was cross sectional and this sudy was descriptive with retrospective data collection by evaluated medical records from 99 patients. This sudy used the total sampling technique.

Based on analysis of 99 sepsis patients, the number of men was higher than women, which was 56.57 and the most suffered by the elderly 55 65 years old patients was 34.34.

This study showed that sepsis patients were 73.74 and septic shock were 26.26. The single most antibiotic commonly used was ceftriaxone and the most combined antibiotic was levofloxacin ceftriaxone. The administration of antibiotics which patient 39 s properly criteria was 49.49 , appropriate indication was 70.71 , and appropriate dosage was 34.34."

"ABSTRAK Latar belakangKematian akibat sepsis dan syok septik pada pasien rawatan Intensive Care Unit (ICU) yaitu 20-30%. Pemberian antibiotik empirik yang tepat merupakan salah satu langkah awal yang sangat penting. Amikasin merupakan salah satu antibiotik terpilih untuk tata laksana sepsis di ICU RSUPN dr. Cipto Mangunkusumo (RSCM). Saat ini belum pernah dilakukan penelitian mengenai ketercapaian kadar terapi amikasin dengan menggunakan dosis standar amikasin pada pasien sepsis dewasa di ICU RSCM, sehingga studi ini menjadi penelitian pertama di Indonesia.Penelitian ini bertujuan untuk mengetahui ketercapaian kadar amikasin optimal pada pasien ICU RSCM.MetodeData dikumpulkan secara potong lintang melalui observasi terhadap hasil pemeriksaan kadar plasma amikasin, pengukuran minimum inhibitory concentration (MIC) dan perhitungan rasio Cmax/MIC pada pasien sepsis di ICU RSCM periode Mei-September tahun 2015.Hasil penelitianProporsi pasien sepsis dengan kadar amikasin optimal ialah sebesar 57% (4/7). Kadar puncak amikasin yang dapat dicapai dengan dosis 1000 mg sekali sehari tanpa menghiraukan berat badan ialah median 86,4 (43,5-238) µg/mL. Pada penelitian ini ditemukan 87% pasien dengan kadar puncak amikasin di atas 64 µg/mL, meskipun amikasin 1000 mg tersebut lebih rendah dari dosis yang dianjurkan untuk sepsis (25 mg/kgBB). Sebagian besar (78,3 %) subyek pada kenyataannya menerima dosis 15-25 mg/kgBB, dengan pemberian 1000 mg amikasin tanpa memperhatikan berat badan. Bakteri yang banyak ditemukan dari hasil kultur pasien sepsis di ICU RSCM, yaitu K. pneumoniae, A. baumanii, P. aeruginosa dan E. coli. Rentang nilai MIC untuk patogen tersebut berturut-turut yaitu 0,75 - >256 µg/mL, 0,75 - >256 µg/mL, 1,5 - >256 µg/mL dan 0,75 - 16) µg/mL. Sebanyak 84% isolat K. pneumoniae masih sensitif terhadap amikasin, diikuti oleh 63% untuk A. baumanii, 47% P. aeruginosa dan 100% untuk E. coli.KesimpulanOptimalitas amikasin terhadap bakteri Gram negatif penyebab sepsis bergantung kadar puncak dan MIC bakteri. Kadar puncak plasma amikasin yang dicapai dengan dosis 1000 mg sekali sehari sangat bervariasi. Pemberian amikasin dengan dosis per kgBB dapat dipertimbangkan. Kepekaan beberapa bakteri Gram negatif terhadap amikasin mulai menurun dengan rentang MIC yang cukup lebar. Pengukuran ketercapaian kadar optimal dalam terapi definitif dapat dilakukan untuk meningkatkan keberhasilan terapi.ABSTRACT BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment."

"Renjatan merupakan sindrom klinis yang ditandai oleh "Prostration" dan gangguan perfusi jaringan. Gangguan ini akan mengakihatkan tidak terpenuhinya kebutuhan metabolisme tubuh. Penyebab renjatan pada anak adalah penadarahan, kehilangan cairan, plasma serta trauma ganda yang menyebabkan gangguan sirkulasi dan respirasi. Dampak lanjut dari renjatan ini dapat menimbulkan kematian atau gejala sisa. Mengingat dampak tersebut maka diperlukan asuhan keperawatan vang intensif, khususnya untuk anak penderita renjatan.

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Shock ix a clinical syndrome characterized by a prostration and an alteration in tissue perfusion. This problem will laid to inadequacy of body metabolism requirements. The main causes of shock in children are bleeding, loss of fluid or plasm and multiple trauma that yield to alteration in circulation and respiration. Further negative impact of shock is squalae or death. Considering the facts above, it is really necessary to provide an intensive nursing care to children who are experiencing shock."

"Latar Belakang. Pasien yang mengalami sepsis dan syok sepsis akan mengalami disfungsi organ akibat reaksi radikal bebas dengan sel endotel mikrovaskular sehingga menyebabkan tingkat morbiditas dan mortalitas yang cukup tinggi. Kondisi difungsi organ dapat diukur melalui perubahan kadar Interleukin-6 (IL-6), C-Reactive Protein (CRP), dan skor Sequential Organ Failure Assessment (SOFA) yang terjadi pada pasien-pasien tersebut. Pemberian asam askorbat yang memiliki kemampuan sebagai free radical scavenging, diharapkan dapat menurunkan proses peradangan atau inflamasi sehingga terjadi perbaikan fungsi organ. Penelitian ini bertujuan untuk mengetahui peran pemberian asam askorbat 6 gram secara intravena terhadap perubahan kadar IL-6, CRP, dan skor SOFA pada pasien sepsis dan syok sepsis di ruang perawatan intensif.Metodologi. Penelitian ini merupakan uji klinis dengan desain uji acak terkontrol, tersamar tunggal yang dilakukan terhadap pasien usia 18-65 tahun dengan diagnosis sepsis atau syok sepsis dalam perawatan 24 jam pertama masuk intensive care unit (ICU) RSUPN Dr. Cipto Mangunkusumo-Jakarta dan ICU RSUP H. Adam Malik-Medan sejak bulan Juli sampai dengan Desember 2019. Sebanyak 49 subyek dirandomisasi menjadi dua kelompok. Kelompok perlakuan (n=23), yang menerima vitamin C 1,5 gram per 6 jam selama 3 hari, dan kelompok kontrol (n=26), yang tidak menerima vitamin C tersebut. Pemeriksaan kadar IL-6, kadar CRP, dan skor SOFA dilakukan pada jam ke-24, 48, dan 72.Hasil. Tidak terdapat perubahan bermakna pada kadar IL-6 (P=0,423), CRP (P=0,080), dan skor SOFA (P=0,809) antara kelompok kontrol dan kelompok perlakuan.Kesimpulan. Pemberian asam askorbat 6 gram secara intravena tidak memberikan perubahan bermakna terhadap kadar IL-6, CRP, dan skor SOFA pada pasien sepsis dan syok sepsis di ruang perawatan intensif.

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Background. Septic and septic shock patients will have organ dysfunctions due to free radical reaction with microvacular endothelial cells, thus morbidity and mortality rate will increase in these conditions. Those organ dysfunctions can be measured through the changes of Interleukin-6 (IL-6) levels, C-Reactive Protein (CRP) levels, and Sequential Organ Failure Assessment (SOFA) scores. The administration of ascorbic acid has a feature known as free radical scavenging. The feature is expected to reduce the inflammatory rate in the organs and to improve the functions. This study was aimed to analyze the intravenous administration effect of 6 grams of ascorbic acid towards the changes of Interleukin-6 levels, C-Reactive Protein levels, and SOFA scores in septic and septic shock patients in intensive care unit

Methods. This was a single blind randomized controlled clinical trial study on patients aged 18-65 years old with septic and septic shock conditions in the first 24 hour care in intensive care unit (ICU) Dr. Cipto Mangunkusumo Hospital-Jakarta and H. Adam Malik Hospital-Medan from July to December 2019. In total, 49 subjects were included in the study and randomized into two groups. Intervetion group (n=23) received 1.5 gram/6 hours of vitamin C in three days consecutively, whereas the control group (n=26) did not receive the vitamin C. Measurements of IL-6 levels, CRP levels, and SOFA scores were performed in the 24th, 48th, and 72th hour.

Results. There were no significant changes of IL-6 levels (p=0.423), CRP levels (p=0.080), and SOFA scores (p=0.809) between the two groups.

Conclusion. The intravenous administration of 6 grams of ascorbic acid did not significantly affect the changes of Interleukin-6 levels, C-Reactive Protein levels, and SOFA scores in septic and septic shock patients in intensive care unit."

"Latar Belakang: Pasien sakit kritis dengan sepsis biasanya menerima volume cairan yang sangat besar menyebabkan balans cairan positif yang sangat signifikan dalam upaya untuk memenuhi kebutuhan kardiak output, tekanan darah sistemik, dan perfusi ke ginjal. Kondisi ini juga ternyata berkaitan dengan angka survival yang buruk. Tujuan dari penelitian ini adalah untuk mengetahui apakah rumatan dini norepinefrin dapat mengurangi pemberian cairan dan mencegah overload pada resusitasi pasien syok septik. Metode: Penelitian ini merupakan penelitian uji klinis acak tidak tersamar dengan subjek penelitian adalah pasien dewasa yang masuk di unit perawatan intensif dan instalasi rawat darurat dari Januari- November 2020 yang didiagnosa dengan syok septik. Terdapat dua kelompok perlakuan, kelompok norepinefrin dini dan kelompok resusitasi cairan 30 ml/kgBB. Dilakukan penilaian terhadap rasio albumin kreatinin urin, peningkatan nilai serum kreatinin, rasio PaO2/FiO2, dan tekanan intraabdominal pada saat diagnosa syok septik ditegakkan, 3 jam dan 24 jam setelah perlakuan diberikan. Data diolah dalam menggunakan perangkat SPSS. Hasil: Berdasarkan analisis didapatkan perbedaan yang bermakna untuk semua variabel penelitian pada kelompok perlakuan resusitasi cairan dibandingkan dengan kelompok norepinefrin. Jumlah pemberian cairan pada kelompok norepinefrin dini rata-rata adalah 2198,63 ml, lebih sedikit dibandingkan pada kelompok resusitasi cairan 30 ml/kgBB dengan rata-rata 3999,30 ml, uji Chi Square p = 0,000. Dengan membandingkan hasil pengukuran terhadap nilai pengukuran awal pada kedua kelompok, overload cairan sangat berisiko terjadi pada kelompok resusitasi cairan 30 ml/kgBB. Didapatkan hubungan yang bermakna pada rasio albumin kreatinin urin, peningkatan nilai serum kreatinin, rendahnya rasio PaO2/FiO2 dan peningkatan tekanan intraabdominal dengan pemberian resusitasi cairan 30 ml/kgBB yang menunjukkan risiko terjadi overload cairan (OR 48,273 ; CI 95% = 16,708-139,472, OR = 73,381 ; CI 95% = 19,955-269,849, OR = 12,225 ; CI 95% = 5,290-28,252, dan OR = 32,667 ; CI 95% = 10,490-101,724).Kesimpulan: Pemberian norepinefrin dini dapat mengurangi pemberian cairan dan mencegah overload pada resusitasi pasien syok septik

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Background: Critically ill patients with sepsis usually receive a very large volume of fluids causing a very significant positive fluid balance in an effort to meet the needs of cardiac output, systemic blood pressure, and perfusion to the kidneys. This condition also turns out to be associated with poor survival rates. The aim of this study was to determine whether early maintenance of norepinephrine can reduce fluid administration and prevent overload in the resuscitation of patients with septic shock.

Methods: This study is a randomized, non-blind clinical trial with the subject of the study being an adult patient diagnosed with septic shock who were admitted to the intensive care unit and emergency care unit from January to November 2020 who were diagnosed with septic shock. There were two treatment groups, the early norepinephrine group and the 30 ml/kgBW fluid resuscitation group. An assessment of the urinary albumin to creatinine ratio, increased serum creatinine value, PaO2/FiO2 ratio, and intraabdominal pressure at the time of diagnosis of septic shock was established, 3 hours and 24 hours after the treatment was given. The data is processed using the SPSS device.

Results: Based on the analysis, it was found that there were significant differences for all study variables in the fluid resuscitation group compared to the norepinephrine group. The amount of fluid administration in the early norepinephrine group averaged 2198.63 ml, less than that in the 30 ml / kgBW fluid resuscitation group with an average of 3999.30 ml, Chi Square test p = 0.000. By comparing the measurement results against the initial measurement values in the two groups, fluid overload was very risky in the 30 ml / kgBW fluid resuscitation group. There is a significant relationship between the urinary albumin to creatinine ratio, the increase in the serum creatinine value, the low PaO2/FiO2 ratio and the increase in intraabdominal pressure with the provision of 30 ml/kgBW fluid resuscitation which indicated the risk of fluid overload (OR 48.273; 95% CI = 16.708-139.472, OR = 73,381; 95% CI = 19,955-269,849, OR = 12,225; 95% CI = 5,290-28,252, and OR = 32,667; 95% CI = 10,490-101,724).

Conclusion: Early norepinephrine administration can reduce fluid administration and prevent overload in the resuscitation of patients with septic shock."

"Latar belakang: Syok septik adalah penyebab utama morbiditas dan mortalitas pada anak. Sampai saat ini data epidemiologi dan faktor risiko mortalitas syok septik pada anak masih terbatas. Tujuan: Mengetahui epidemiologi dan faktor risiko mortalitas syok septik pada anak. Metode: Penelitian retrospektif dilakukan di RSUP DR. Sardjito dengan mencatat data rekam medis pasien anak dengan diagnosis syok septik periode 1 Nopember 2011 sampai 30 Juni 2014. Hasil: Didapatkan 136 kejadian syok septik dalam kurun waktu pengambilan data. Median usia pasien adalah 16 bulan, 52.2% berjenis kelamin laki-laki dan 50% kejadian syok septik terjadi di PICU. Median skor awal PRISM III adalah 10 dan median skor awal PELOD adalah 22. Median hari perawatan di PICU adalah 4 hari. Mortalitas sebesar 88.2%. Pada tata laksana awal, 72.8% subyek harus mendapat terapi oksigen dengan ETT, 94,9% subyek mendapat antibiotik dalam waktu 1 jam pertama. Sebanyak 48.5% membutuhkan cairan kristaloid dan koloid dengan median jumlah 40 ml/kgbb. Median waktu yang diperlukan untuk menyelesaikan tata laksana cairan adalah 60 menit. Alasan penghentian terapi cairan resusitasi pada 44.8% subyek adalah karena sudah tidak respon cairan. Tunjangan ventilator mekanik dibutuhkan pada 79.4% dan katekolamin terbanyak yang dibutuhkan adalah dobutamin sebanyak 55.9% subyek. Median waktu tata laksana yang dibutuhkan sampai syok teratasi adalah 8 jam Prosentase fluid overload > 10% ditemukan pada 58.8% subyek. Dari multivariat analisis ditemukan faktor prediktor terjadinya kematian pada syok septik adalah FO >10% OR 6.69 (95% IK 1.35-33.21) dan diperlukannya tunjangan Ventilator Mekanik pada pasien syok septik yang menunjukkan tanda distress respirasi OR 16.38 (95% IK 2.69-99.66). Simpulan Faktor risiko kematian syok septik pada anak dari penelitian ini adalah fluid overload dan penggunaan ventilator mekanik pada pasien syok septik yang menunjukkan tanda distress respirasi.

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Background: Shock is a major cause of morbidity and mortality in children. To date epidemiological data and predictors of mortality of septic shock in children is limited.

Objective: to know the epidemiology and mortality risk factor of septic shock in children.

Methods: A retrospective study was conducted in DR. Sardjito general hospital with medical record data recorded diagnosis of septic shock in children period from 1 november 2011 to June 30, 2014.

Results: A total of 136 septic shock events in the period of data collection. The median age of patients was 16 months, 52.2% male sex and 50% incidence of septic shock occurred in the PICU. Median early PRISM III score was 10 and the median score was 22. The median initial PELOD day care in the PICU was 4 days. A mortality of 88.2%. At the initial steps, 72.8% of subjects received oxygen therapy with ETT, antibiotics within 1 hour of the first was done in 94.9% of subjects. A total of 48.5% in need of crystalloids and colloids with a median amounts of 40 ml / kg. The median time required to complete the administration of fluids is 60 minutes. Reason for termination of resuscitation fluid therapy was 44.8% because had no response to fluid therapy. Mechanical ventilator allowance required at 79.4% and catecholamines most needed is dobutamine as 55.9%. Median time needed to overcome the shock is 8 hours. Percentage of fluid overload> 10% was found in 58.8% of subjects. Multivariate analysis of predictor factors for mortality found in septic shock is FO> 10% OR 6.69 (95% CI 1.35- 33.21) and the need for mechanical ventilaton support in patient with distress respiration OR 16.38 (95% IK 2.69-99.66).

Conclusion: Mortality risk factor of septic shock in children in this research is fluid overload."

"Latar Belakang : Syok sepsis merupakan kondisi mengancam nyawa dengan beban morbiditas dan mortalitas tinggi terutama di Asia Tenggara. Perencanaan resusitasi cairan yang optimal pada pasien sepsis membutuhkan panduan status hemodinamik tubuh, namun pengukuran Central Venous Pressure (CVP) yang saat ini paling umum digunakan merupakan tindakan invasif dengan segala kekurangannya. Sejumlah penelitian sebelumnya mengajukan pemeriksaan ultrasonografi vena cava inferior (USG IVC) sebagai metode alternatif estimasi status hemodinamik tubuh, namun dengan hasil yang bervariasi. Diskrepansi hasil penelitian sebelumnya dan kurangnya data penelitian pada populasi syok sepsis di Indonesia menunjukkan perlunya ada penelitian lebih lanjut. Tujuan : Penelitian ini bertujuan untuk mengetahui korelasi antara parameter USG IVC berupa diameter, Collapsibility Index (CI), dan velositas maksimal (maxV) terhadap nilai CVP. Metode : Desain penelitian merupakan studi korelasi dengan teknik potong lintang. Data primer didapatkan dari hasil pemeriksaan USG IVC dan CVP menggunakan manometer manual dari sampel pasien syok sepsis yang dirawat di RSUPN Cipto Mangunkusumo dengan waktu penelitian Juli hingga Oktober 2020. Pengukuran diameter, CI, dan maxV dari IVC diambil di regio subxiphoid, dilakukan sendiri oleh peneliti dengan supervisi langsung dari spesialis radiologi konsultan abdomen. Hasil : Didapatkan 27 sampel USG IVC tanpa perbedaan proporsi yang bermakna antar subyek berdasarkan umur dan jenis kelaminnya. Didapatkan korelasi positif sedang antara diameter dengan nilai CVP (r = 0,459, p = 0,016), korelasi negatif sedang antara CI dengan nilai CVP (r = - 0,571, p = 0,002), dan tidak ada korelasi yang bermakna secara statistik antara maxV dengan nilai CVP (r = 0,074, p = 0,715). Kesimpulan : Korelasi bermakna antara diameter dan CI IVC terhadap nilai CVP menunjukkan bahwa pemeriksaan USG IVC dapat digunakan sebagai metode pemeriksaan alternatif non-invasif untuk estimasi nilai CVP dalam perencanaan penatalaksanaan pasien syok sepsis.

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Background : Septic shock is one of life-threatening condition with high morbidity and mortality rate, especially in the South East Asia. Optimal fluid resuscitation planning requires adequate portrayal of hemodynamic status, but the most often used indicator, Central Venous Pressure (CVP), is an invasive procedure with all its drawbacks. Several studies has been done worldwide to propose Inferior Vena Cava Ultrasonography (IVC USG) as an alternative method to estimate hemodynamic status, to varying degree of success. These discrepancies from previous studies, and the lack of data for septic shock population in Indonesia suggests the need for further study.

Objective : This study aims to determine the correlation strength between IVC USG parameters such as diameter, Collapsibility Index (CI), and maximum velocity (maxV) with CVP. Method : The study design is cross-sectional correlation study. Primary data was acquired from IVC USG examination results and CVP values was acquired by manual measurement from septic shock patients in Cipto Mangunkusumo National Central General Hospital (RSUPN CM) from July until October 2020. Measurements of diameter, CI, and maxV were done in the subxiphoid region under direct supervision from abdominal consultant radiologist. Result: In total, 27 samples of IVC USG were acquired without statistically significant difference of proportion across age and gender. Moderate positive correlation were found between diameter and CVP (r = 0,459, p = 0,016). Moderate negative correlation were found between CI and CVP (r = - 0,571, p = 0,002). No statistically significant correlation were found between maxV and CVP (r = 0,074, p = 0,715). Conclusion : Significant correlation between IVC diameter and CI with CVP values implies that IVC USG is an acceptable non-invasive alternative method to estimate CVP values in accordance to septic shock therapy planning."