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Abstrak :
Latar Belakang: Sepsis merupakan salah satu masalah kesehatan di rumah sakit termasuk di ruang Intensive Care Unit (ICU) dan angka kematiannya masih tetap tinggi meskipun dengan tatalaksana yang maksimal dan biaya yang besar. Kematian merupakan hal yang sulit untuk diprediksi. Pasien yang telah diresusitasi dengan baik masih berpeluang untuk mengalami kematian karena proses disfungsi organ yang terus berlanjut akibat tingginya tingkat inflamasi. Inflamasi yang tidak terkontrol memicu stress oksidasi dan necroptosis. Penelitian terakhir menunjukkan kadar protein carbonyl (PCO) dan receptor-interacting protein kinase 3 (RIPK3) tinggi pada pasien sepsis dan dapat digunakan untuk memprediksi kematian. Penelitian ini bertujuan untuk menilai seberapa besar kegagalan resusitasi, kadar PCO, dan kadar RIPK3 dapat memprediksi kematian pada pasien sepsis. Metode: Rancangan penelitian ini adalah kohort prospektif di ruang resusitasi dan ICU RSUP. Dr. Moh. Hoesin (RSMH) Palembang. Penelitian dimulai setelah sertifikat etik dan izin lokasi diterbitkan sejak bulan Februari sampai Agustus 2019. Kriteria penerimaan meliputi pasien berusia 18 tahun atau lebih yang didiagnosis sepsis. Kriteria penolakan meliputi keluarga menolak diikutsertakan dalam penelitian, pasien tidak dirawat di ICU, terlambat didiagnosis (lebih dari 24 jam), hamil dan didiagnosis mati batang otak. Kriteria pengeluaran meliputi pasien meninggal kurang dari 4 jam setelah diagnosis ditegakkan dan pasien tidak dapat dilakukan follow up dalam waktu 28 hari. Tim peneliti yang telah dilatih sebelumnya mengidentifikasi semua pasien yang memenuhi kriteria penelitian. Semua subjek penelitian mendapatkan resusitasi standar dan diambil sampel darah untuk diperiksakan ke laboratorium. Pasien diamati selama 28 hari: apakah mengalami kematian atau tidak. Kegagalan resusitasi didefinisikan sebagai kadar laktat ≥2 mmol/l atau reduksi laktat <20%. Data yang didapatkan dianalisis dengan uji statistik yang sesuai menggunakan piranti lunak program STATA. Hasil: Didapatkan total 72 subjek penelitian, 13 dikeluarkan karena meninggal kurang dari 4 jam setelah diagnosis ditegakkan. Dari hasil analisis bivariat didapatkan hubungan antara kegagalan resusitasi (RR 1,36; IK95% 0,965-1,916; p 0,085), kadar PCO (RR 2,37; IK95% 1,348-4,194; p 0,0001), dan kadar RIPK3 (RR 5,86; IK95% 2,07-16,61; p <0,0001). Dari hasil multivariat hanya didapatkan satu variabel yang bermakna yaitu kadar RIPK3 (RR 5,39; IK95% 1,490-19,478; p 0,010). Setelah dikontrol dengan variabel perancu usia, komorbiditas dan skor APACHE II didapatkan variabel RIPK3 memiliki RR 4,64 dengan IK95% 1,233- 17,479; p 0,023). Simpulan: Kegagalan resusitasi, kadar PCO dan kadar RIPK3 dapat memprediksi kematian pada pasien sepsis. ...... Background: Sepsis remains one of the health problems at the hospital including intensive care unit (ICU) since its mortality is still high despite maximal efforts on therapy. Mortality is an unpredictable event. Patients who were properly resuscitated still have a probability of mortality because of severe inflammatory state which may lead to ongoing organ dysfunctions. Uncontrolled inflammation will trigger oxidative stress and necroptosis. Recent study showed that high level of protein carbonyl (PCO) and receptor-interacting protein kinase 3 (RIPK3) in septic patients could be used to predict mortality. This study wished to analyze the ability resuscitation failure, PCO level and RIPK3 level to predict mortality in septic patients. Methods: This prospective cohort study was conducted at resuscitation room and ICU of RSUP. dr. Moh. Hoesin (RSMH), a single tertiary teaching hospital in Palembang, South Sumatera. This study was started after ethical and location authorization were unleashed in February to August 2019. Inclusion criteria were 18 years old or above patients that were diagnosed with sepsis. Exclusion criteria were patients whose family did not give any consent to participate the study, patients that were not treated at the ICU, had a late diagnosis (>24 h), pregnant, and diagnosed with brain dead. Drop out criteria including died <4 h after diagnosed and patients that could not be followed in 28 days. Investigators were trained to identified all eligible patients. Subjects had a standard resuscitation and their blood was taken to be examined at the laboratory. Patients were observed in 28 days whether there were any mortality or not. Failed resuscitation defined by examined lactate level ≥ 2 mmol/l or lactate reduction<20%. Data was statistically analyzed with STATA™. Results: Seventy two subjects were included to the study but 13 of them were dropped out because died within 4 h after diagnosed. From bivariate analysis, there was an association between failed resuscitation (RR 1.36; CI95% 0.965-1.916; p 0.085), PCO level (RR 2.37; CI95% 1.348-4.194; p 0.0001), and RIPK3 level (RR 5,86; CI95% 2.07-16.61; p <0.0001). From multivariate analysis using cox regression time constant, the only variable statistically significant was RIPK3 (RR 5.39; CI95% 1.490-19.478; p 0.010). After adjusted by confounding variables, including age, comorbidities, and APACHE II score, RIPK3 had RR 4.64 with CI 95% 1.233-17.479; p 0.023. Conclusions: Failed resuscitation, PCO level, and RIPK3 level can predict mortality in sepsis patients

Abstrak :
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). ......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).

Abstrak :
Latar Belakang: Penatalaksanaan klinis pada pasien COVID-19 mencakup tindakan pencegahan dan pengendalian infeksi serta perawatan suportif termasuk oksigen tambahan dan dukungan ventilasi mekanis. Pemberian terapi antivirus diharapkan dapat mengurangi tingkat keparahan dan mortalitas. Di antara terapi antivirus yang diberikan, favipiravir dan remdesivir merupakan terapi antivirus untuk pasien dewasa dengan COVID-19 derajat berat atau kritis yang direkomendasikan pemberiannya menurut Protokol Tata Laksana COVID-19. Tujuan dari penelitian ini adalah membandingkan tingkat kesembuhan pasien COVID-19 yang diterapi dengan remdesivir dan favipiravir ditinjau dari CRP, viral clearance, dan NLR. Metode: Penelitian ini merupakan penelitian observasional dengan desain kohort retrospektif. Kelompok yang mendapat paparan terapi antivirus favipiravir dan kelompok yang mendapat paparan terapi antivirus remdesivir diikuti sampai terjadinya outcome. Data yang akan digunakan adalah data sekunder dari rekam medis pasien COVID-19 yang dirawat di ruang Intensif Care Unit (ICU) dan High Care Unit (HCU) RSUD Tarakan dengan pemeriksaan RT-PCR positif berusia minimal 18 tahun yang mendapat terapi antivirus remdesivir dan favipiravir pada bulan April 2020-September 2021. Uji statistik menggunakan chi square yang dilanjutkan dengan uji regresi logistik untuk menilai secara multivariat jika memenuhi persyaratan. Hasil: Pada penelitian ini didapat hubungan bermakna antara antivirus yang digunakan pasien COVID-19 dengan tingkat kesembuhan (OR 0, 384; CI 95% = 0,234-0,606 ). Tingkat kesembuhan lebih baik berdasarkan CRP adalah 35,5% pada remdesivir dan 51,4% pada favipiravir (OR 0,690; CI 95% = 0,525-0,907), berdasarkan RNL adalah 14,2% pada remdesivir dan 41,1% pada favipiravir (OR 0,345; CI 95% = 0,220-0,541) dan berdasarkan viral clearence adalah 20 hari pada remdesivir dan 21 hari pada favipiravir untuk virus tidak lagi terdeteksi (OR 1,79; CI 95% = 0,804-1,730). Kesimpulan : Tingkat kesembuhan lebih baik sebesar 14,2% pada kelompok remdesivir dibandingkan kelompok favipiravir yang sembuh lebih baik sebesar 37%. Remdesivir memberikan tingkat kesembuhan sebesar 0,384 kali lebih baik dari favipiravir. ......Background: Clinical management of COVID-19 patients includes infection prevention and control measures as well as supportive care including supplemental oxygen and mechanical ventilation support. Giving antiviral therapy is expected to reduce the severity and mortality. Among the antiviral therapies given, favipiravir and remdesivir are antiviral therapies for adult patients with severe or critically ill COVID-19 that are recommended according to the COVID-19 Management Protocol. This study aims to compare the cure rates of COVID-19 patients treated with remdesivir and favipiravir in terms of CRP, viral clearance, and NLR. Methods: This study is an observational study with a retrospective cohort design. The group exposed to antiviral therapy with favipiravir and the group exposed to antiviral therapy remdesivir were followed until the outcome. The data to be used is secondary data from medical records of COVID-19 patients treated in the intensive care unit (ICU) and High Care Unit (HCU) of Tarakan Hospital with positive RT-PCR examination aged at least 18 years who received antiviral therapy remdesivir and favipiravir in April 2020-September 2021. Admission criteria included patients aged at least 18 years who had confirmed COVID-19 with positive RT-PCR who were receiving remdesivir or favipiravir therapy. Exclusion criterias were pregnancy and breastfeeding. Statistical test using chi square followed by logistic regression test to assess multivariately if it meets the requirements. Result: In this study, there was a significant relationship between the antiviral used by COVID-19 patients and the recovery rate (OR 0,384; 95% CI = 0,234-0,606), The better recovery rate based on CRP was 35.5% for remdesivir and 51.4% for favipiravir (OR 0.690; 95% CI = 0.525-0.907), based on RNL was 14.2% for remdesivir and 41.1% for favipiravir ( OR 0.345; 95% CI = 0.220 – 0.541) and based on viral clearance, it took 20 days on remdesivir and 21 days on favipiravir for virus no longer detectable Conclusion: There was a significant relationship of the recovery rate in the two antiviral groups. The recovery rate for COVID-19 was better by 14.2% in the remdesivir group compared to the favipiravir group which recovered better by 37%. Remdesivir provides a recovery rate of 0,384 times better than favipiravir.

Abstrak :
Latar Belakang: Penatalaksanaan klinis pada pasien COVID-19 mencakup tindakan pencegahan dan pengendalian infeksi serta perawatan suportif termasuk oksigen tambahan dan dukungan ventilasi mekanis. Pemberian terapi antivirus diharapkan dapat mengurangi tingkat keparahan dan mortalitas. Di antara terapi antivirus yang diberikan, favipiravir dan remdesivir merupakan terapi antivirus untuk pasien dewasa dengan COVID-19 derajat berat atau kritis yang direkomendasikan pemberiannya menurut Protokol Tata Laksana COVID-19. Tujuan dari penelitian ini adalahmembandingkan tingkat kesembuhan pasien COVID-19 yang diterapi dengan remdesivir dan favipiravir ditinjau dari CRP, viral clearance, dan NLR. Metode: Penelitian ini merupakan penelitian observasional dengan desain kohort retrospektif. Kelompok yang mendapat paparan terapi antivirus favipiravir dan kelompok yang mendapat paparan terapi antivirus remdesivir diikuti sampai terjadinya outcome. Data yang akan digunakan adalah data sekunder dari rekam medis pasien COVID-19 yang dirawat di ruang Intensif Care Unit (ICU) dan High Care Unit (HCU) RSUD Tarakan dengan pemeriksaan RT-PCR positif berusia minimal 18 tahun yang mendapat terapi antivirus remdesivir dan favipiravir pada bulan April 2020 – September 2021.Uji statistik menggunakan chi square yang dilanjutkan dengan uji regresi logistik untuk menilai secara multivariat jika memenuhi persyaratan. Hasil: Pada penelitian ini didapat hubungan bermakna antara antivirus yang digunakan pasien COVID-19 dengan tingkat kesembuhan (OR 0, 384; CI 95% = 0,234 – 0,606 ). Tingkat kesembuhan lebih baik berdasarkan CRP adalah 35,5% pada remdesivir dan 51,4% pada favipiravir (OR 0,690; CI 95% = 0,525-0,907), berdasarkan RNL adalah 14,2% pada remdesivir dan 41,1% pada favipiravir (OR 0,345; CI 95% = 0,220 – 0,541) dan berdasarkan viral clearence adalah 20 hari pada remdesivir dan 21 hari pada favipiravir untuk virus tidak lagi terdeteksi (OR 1,79; CI 95% = 0,804-1,730). Kesimpulan : Tingkat kesembuhan lebih baik sebesar 14,2% pada kelompok remdesivir dibandingkan kelompok favipiravir yang sembuh lebih baik sebesar 37%. Remdesivir memberikan tingkat kesembuhan sebesar 0,384 kali lebih baik dari favipiravir. ......Background: Clinical management of COVID-19 patients includes infection prevention and control measures as well as supportive care including supplemental oxygen and mechanical ventilation support. Giving antiviral therapy is expected to reduce the severity and mortality. Among the antiviral therapies given, favipiravir and remdesivir are antiviral therapies for adult patients with severe or critically ill COVID-19 that are recommended according to the COVID-19 Management Protocol. This study aims to compare the cure rates of COVID-19 patients treated with remdesivir and favipiravir in terms of CRP, viral clearance, and NLR. Methods: This study is an observational study with a retrospective cohort design. The group exposed to antiviral therapy with favipiravir and the group exposed to antiviral therapy remdesivir were followed until the outcome. The data to be used is secondary data from medical records of COVID-19 patients treated in the intensive care unit (ICU) and High Care Unit (HCU) of Tarakan Hospital with positive RT-PCR examination aged at least 18 years who received antiviral therapy remdesivir and favipiravir in April 2020 – September 2021. Admission criteria included patients aged at least 18 years who had confirmed COVID-19 with positive RT-PCR who were receiving remdesivir or favipiravir therapy. Exclusion criterias were pregnancy and breastfeeding. Statistical test using chi square followed by logistic regression test to assess multivariately if it meets the requirements. Result: In this study, there was a significant relationship between the antiviral used by COVID-19 patients and the recovery rate (OR 0,384; 95% CI = 0,234 – 0,606), The better recovery rate based on CRP was 35.5% for remdesivir and 51.4% for favipiravir (OR 0.690; 95% CI = 0.525-0.907), based on RNL was 14.2% for remdesivir and 41.1% for favipiravir ( OR 0.345; 95% CI = 0.220 – 0.541) and based on viral clearance, it took 20 days on remdesivir and 21 days on favipiravir for virus no longer detectable Conclusion: There was a significant relationship of the recovery rate in the two antiviral groups. The recovery rate for COVID-19 was better by 14.2% in the remdesivir group compared to the favipiravir group which recovered better by 37%. Remdesivir provides a recovery rate of 0,384 times better than favipiravir.

Abstrak :
Latar Belakang: Peningkatan konsumsi oksigen selama tindakan bedah risiko tinggi dapat menyebabkan gangguan oksigenasi organ vital, sehingga tubuh akan mengambil kompensasi, misalnya melalui vasokonstriksi splanknik. Saluran cerna akan rentan terhadap kerusakan yang akan mengakibatkan disfungsi gastrointestinal. Lama perawatan ICU dan penggunaan ventilasi mekanik lebih panjang pada pasien-pasien yang mengalami disfungsi gastrointestinal. Oleh karena itu pada pasien yang berisiko perlu mendapat perhatian dan tatalaksana lebih awal. Metode: Penelitian ini adalah kohort prospektif yang dilakukan di RSCM selama bulan Februari sampai Juni 2023 yang bertujuan untuk mengetahui peran kadar I-FABP plasma, skor SOFA, balans cairan, dan dosis vasopresor dalam memprediksi terjadinya disfungsi gastrointestinal pada pasien pascabedah risiko tinggi yang dirawat di ICU. Sebanyak 66 subyek diambil dengan metode consecutive sampling. Pengambilan data skor SOFA, balans cairan dan dosis vasopresor dilakukan pada saat pasien admisi di ICU, sedangkan kadar I-FABP diukur pada saat admisi dan 24 jam kemudian. Analisis data dilakukan dengan SPSS. Hasil: Terdapat perbedaan bermakna kadar I-FABP hari ke-0 (p=0,001) dan hari ke-1 (p=0,001), serta skor SOFA (p=0,03) pada subjek yang mengalami disfungsi gastrointestinal dengan yang tidak mengalami disfungsi gastrointestinal. Tidak terdapat perbedaan bermakna pada balans cairan dan rerata dosis vasopresor pada subjek yang mengalami disfungsi gastrointestinal dengan yang tidak mengalami disfungsi gastrointestinal. Kadar I-FABP plasma, dengan titik potong ≥2.890,27 pg/ml pada hari ke-0 dan ≥1.501,2 pg/ml pada hari ke-1 dapat menjadi prediktor disfungsi gastrointestinal pada pasien pascabedah risiko tinggi yang dirawat di ICU. Simpulan: Kadar I-FABP plasma dapat memprediksi kejadian disfungsi gastro- intestinal pada pasien pascabedah risiko tinggi yang dirawat di ICU. ......Background: Increased oxygen demand during high-risk surgery can lead to impaired oxygenation of vital organs so that the body will compensate, for example, through splanchnic vasoconstriction. The gastrointestinal tract will be prone to injury, resulting in gastrointestinal dysfunction. ICU length of stay and use of mechanical ventilation are longer in patients with gastrointestinal dysfunction. Therefore, patients who are at risk need to receive early consideration and management. Methods: This is a prospective cohort study conducted at RSCM from February to June 2023, which aims to determine the role of plasma I-FABP levels, SOFA scores, fluid balance, and vasopressor doses in predicting the incidence of postoperative gastrointestinal dysfunction in high-risk surgery patients admitted to the ICU. A total of 66 subjects were taken by consecutive sampling method. SOFA score data, fluid balance, and vasopressor doses were collected at admission to the ICU, while I-FABP levels were measured at admission and 24 hours later. Data analysis was performed with SPSS. Results: There was a significant difference in I-FABP levels on day 0 (p=0.001) and day 1 (p=0.001) and the SOFA score (p=0.03) in subjects with gastrointestinal dysfunction and those without gastrointestinal dysfunction. There were no significant differences in fluid balance and the average dose of vasopressors in subjects with gastrointestinal dysfunction and those without gastrointestinal dysfunction. Plasma I- FABP levels, with cut points of ≥2,890.27 pg/ml on day 0 and ≥1,501.2 pg/ml on day 1, can be a predictor of postoperative gastrointestinal dysfunction in high-risk surgery patients admitted to the ICU. Conclusions: Plasma I-FABP levels can predict the incidence of postoperative gastrointestinal dysfunction in high-risk surgery patients admitted to the ICU.