Pub Date : 2023-07-29DOI: 10.20473/ijar.v5i22023.64-71
D. Rachmawati, Arie Utariani, P. B. Notopuro, B. Semedi
Introduction: Sepsis and septic shock are organ dysfunctions caused by the dysregulation of the body's response to infection and are the most common causes of death. Objective: This study aims to describe the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lactate levels in patients with sepsis and septic shock who died in the Intensive Care Unit (ICU). Materials and Methods: An observational retrospective study was conducted by examining the medical record data of sepsis and sepsis shock patients who were hospitalized in the ICU of Dr. Soetomo General Academic Hospital Surabaya from January to December 2019. Results: The study sample was 28 patients: 16 with sepsis and 12 with septic shock. Fifteen patients (53.6%) were women. The patients’ mean age was 53.18 ± 13.61 years, and most patients (8 patients, 28.6%) belonged to the late adult age group (36-45 years). The most common comorbidities were diabetes mellitus and hypertension (30.8%). The highest incidence of infection in both groups occurred in the lungs (42.9%). Most of the patients had high SOFA scores, in the moderate (7-9) to severe (≥ 10) category (39.3%). Almost all patients (82.1%) were treated for less than one week. The hematological examination within the first 24 hours showed a leukocyte value of 16,995 (Leukocytosis) and a platelet value of 279,500 (Normal). The NLR of septic shock patients (31.38±55.61) was higher than the NLR of sepsis patients (23.75±22.87). The PLR of septic shock patients (534.02±1000.67) was lower than the PLR of patients (802.93±1509.89). Lastly, the lactate levels in septic shock patients (3.84±1.99) were higher than in sepsis patients (1.97±1.06). Conclusion: There were no significant differences in the NLR and PLR values between sepsis and septic shock patients, but there were significant differences in their initial lactate levels.
{"title":"The Difference in Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), and Lactate Levels Between Sepsis and Septic Shock Patients Who Died in The ICU","authors":"D. Rachmawati, Arie Utariani, P. B. Notopuro, B. Semedi","doi":"10.20473/ijar.v5i22023.64-71","DOIUrl":"https://doi.org/10.20473/ijar.v5i22023.64-71","url":null,"abstract":"Introduction: Sepsis and septic shock are organ dysfunctions caused by the dysregulation of the body's response to infection and are the most common causes of death. Objective: This study aims to describe the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lactate levels in patients with sepsis and septic shock who died in the Intensive Care Unit (ICU). Materials and Methods: An observational retrospective study was conducted by examining the medical record data of sepsis and sepsis shock patients who were hospitalized in the ICU of Dr. Soetomo General Academic Hospital Surabaya from January to December 2019. Results: The study sample was 28 patients: 16 with sepsis and 12 with septic shock. Fifteen patients (53.6%) were women. The patients’ mean age was 53.18 ± 13.61 years, and most patients (8 patients, 28.6%) belonged to the late adult age group (36-45 years). The most common comorbidities were diabetes mellitus and hypertension (30.8%). The highest incidence of infection in both groups occurred in the lungs (42.9%). Most of the patients had high SOFA scores, in the moderate (7-9) to severe (≥ 10) category (39.3%). Almost all patients (82.1%) were treated for less than one week. The hematological examination within the first 24 hours showed a leukocyte value of 16,995 (Leukocytosis) and a platelet value of 279,500 (Normal). The NLR of septic shock patients (31.38±55.61) was higher than the NLR of sepsis patients (23.75±22.87). The PLR of septic shock patients (534.02±1000.67) was lower than the PLR of patients (802.93±1509.89). Lastly, the lactate levels in septic shock patients (3.84±1.99) were higher than in sepsis patients (1.97±1.06). Conclusion: There were no significant differences in the NLR and PLR values between sepsis and septic shock patients, but there were significant differences in their initial lactate levels.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116589398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-29DOI: 10.20473/ijar.v5i22023.81-87
A. Tantri, H. Angkasa, Riyadh Firdaus, Tasya Claudia, Ignatia Novita Tantri
Introduction: Opioid-free anesthesia (OFA) is an alternative to Opioid based anesthesia (OBA) which uses multimodal analgesia to replace opioids. However, its feasibility, safety, and exact recommended combination remain debatable. Case Series: We administered OFA in 5 types of elective ophthalmic surgeries under general anesthesia in ASA 1-2 adult patients (evisceration, ocular exenteration, periosteal graft, scleral buckling, vitrectomy, and dacryocystorhinostomy) to assess the feasibility of OFA. We gave preoperative Paracetamol and Pregabalin with Dexmedetomidine as a loading dose (1 mcg/kg in 10 minutes) and maintenance at 0.7 mcg kg-1 per hour. Induction was performed using Propofol 1-2 mg kg-1, Lidocaine 1-1.5 mg kg-1 IV, and Rocuronium. Before the incision, Dexamethasone and Ranitidine were given. Maintenance was done using Dexmedetomidine and Sevoflurane. Fentanyl was used as rescue analgesia if required. Dexmedetomidine was stopped 15-30 minutes before the procedure ended. Metoclopramide and Ketorolac were given as postoperative management. Throughout the procedure, our patients had stable hemodynamics, did not experience life-threatening bradycardia, and did not require rescue analgesia. All patients regained full consciousness and did not experience postoperative nausea and vomiting, emergency delirium, or coughing. Conclusion: Multimodal analgesia was an excellent intraoperative OFA regimen as an alternative to OBA and provided controlled hypotension in ocular surgery. Safe OFA is possible with combined analgesia regimens, strict intraoperative monitoring, and adequate anesthesia depth.
{"title":"Opioid-Free Anesthesia in Ophthalmic Surgeries","authors":"A. Tantri, H. Angkasa, Riyadh Firdaus, Tasya Claudia, Ignatia Novita Tantri","doi":"10.20473/ijar.v5i22023.81-87","DOIUrl":"https://doi.org/10.20473/ijar.v5i22023.81-87","url":null,"abstract":"Introduction: Opioid-free anesthesia (OFA) is an alternative to Opioid based anesthesia (OBA) which uses multimodal analgesia to replace opioids. However, its feasibility, safety, and exact recommended combination remain debatable. Case Series: We administered OFA in 5 types of elective ophthalmic surgeries under general anesthesia in ASA 1-2 adult patients (evisceration, ocular exenteration, periosteal graft, scleral buckling, vitrectomy, and dacryocystorhinostomy) to assess the feasibility of OFA. We gave preoperative Paracetamol and Pregabalin with Dexmedetomidine as a loading dose (1 mcg/kg in 10 minutes) and maintenance at 0.7 mcg kg-1 per hour. Induction was performed using Propofol 1-2 mg kg-1, Lidocaine 1-1.5 mg kg-1 IV, and Rocuronium. Before the incision, Dexamethasone and Ranitidine were given. Maintenance was done using Dexmedetomidine and Sevoflurane. Fentanyl was used as rescue analgesia if required. Dexmedetomidine was stopped 15-30 minutes before the procedure ended. Metoclopramide and Ketorolac were given as postoperative management. Throughout the procedure, our patients had stable hemodynamics, did not experience life-threatening bradycardia, and did not require rescue analgesia. All patients regained full consciousness and did not experience postoperative nausea and vomiting, emergency delirium, or coughing. Conclusion: Multimodal analgesia was an excellent intraoperative OFA regimen as an alternative to OBA and provided controlled hypotension in ocular surgery. Safe OFA is possible with combined analgesia regimens, strict intraoperative monitoring, and adequate anesthesia depth.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126012658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-29DOI: 10.20473/ijar.v5i22023.72-80
Rayhandika, A. Y. Jufan, Y. Widyastuti, J. Kurniawaty
Introduction: ICU service quality must continuously improve to provide better patient service. One of these improvement efforts is the use of a risk prediction system to predict mortality rates in the ICU by utilizing risk factors. This system helps healthcare services perform evaluations and comparative audits of intensive services, which can also aid with more targeted planning. APACHE IV is considered to have good validity. However, its predictive capabilities may change over time due to various factors, such as the pandemic, where changes in the case mix may affect its predictive abilities. Therefore, this research tests the validity of APACHE IV on the Indonesian population through Dr. Sardjito Hospital patients. The findings can be utilized for future use and risk stratification, and ICU quality benchmarking. Objectives: This study aims to assess the validity of the APACHE IV score in ICU Mortality prediction in Dr. Sardjito Hospital for medical patients, surgical patients, and patients with both cases during the pandemic. Materials and Method: This study used retrospective data from 336 patients at Dr. Sardjito Hospital Yogyakarta from the 1st of January 2020 to the 31st of December 2021. All data required for calculating the APACHE IV score was collected, and the patient’s observed ICU Mortality was used. The model’s predictive validity is measured by finding the discrimination and calibration of the APACHE IV score and comparing it to the observed ICU mortality. Validation was also conducted separately for medical and surgical cases. Results: APACHE IV shows good discrimination ability in all cases (AUC-ROC 95% CI: 0.819 [0.772-0.866]) but poor calibration (p = 0.023) for mortality prediction in the ICU. For medical cases, the discrimination ability is poor but still acceptable (AUC-ROC 95% CI: 0.698 [0.614-0.782]), and in surgical cases, the discrimination ability is good (AUC-ROC 95% CI: 0.848 [0.776-0.921]). Both cases showed good calibration (p: medical = 0.569, surgical = 0.579) in predicting mortality during the pandemic. Conclusion: APACHE IV showed good discrimination but poor calibration ability for predicting mortality for all ICU patients during the pandemic era. Mortality prediction for surgical cases showed good discrimination and calibration. However, medical cases showed poor discrimination but good calibration.
{"title":"Validation of the APACHE IV Score for ICU Mortality Prediction in Dr. Sardjito Hospital During the Pandemic Era","authors":"Rayhandika, A. Y. Jufan, Y. Widyastuti, J. Kurniawaty","doi":"10.20473/ijar.v5i22023.72-80","DOIUrl":"https://doi.org/10.20473/ijar.v5i22023.72-80","url":null,"abstract":"Introduction: ICU service quality must continuously improve to provide better patient service. One of these improvement efforts is the use of a risk prediction system to predict mortality rates in the ICU by utilizing risk factors. This system helps healthcare services perform evaluations and comparative audits of intensive services, which can also aid with more targeted planning. APACHE IV is considered to have good validity. However, its predictive capabilities may change over time due to various factors, such as the pandemic, where changes in the case mix may affect its predictive abilities. Therefore, this research tests the validity of APACHE IV on the Indonesian population through Dr. Sardjito Hospital patients. The findings can be utilized for future use and risk stratification, and ICU quality benchmarking. Objectives: This study aims to assess the validity of the APACHE IV score in ICU Mortality prediction in Dr. Sardjito Hospital for medical patients, surgical patients, and patients with both cases during the pandemic. Materials and Method: This study used retrospective data from 336 patients at Dr. Sardjito Hospital Yogyakarta from the 1st of January 2020 to the 31st of December 2021. All data required for calculating the APACHE IV score was collected, and the patient’s observed ICU Mortality was used. The model’s predictive validity is measured by finding the discrimination and calibration of the APACHE IV score and comparing it to the observed ICU mortality. Validation was also conducted separately for medical and surgical cases. Results: APACHE IV shows good discrimination ability in all cases (AUC-ROC 95% CI: 0.819 [0.772-0.866]) but poor calibration (p = 0.023) for mortality prediction in the ICU. For medical cases, the discrimination ability is poor but still acceptable (AUC-ROC 95% CI: 0.698 [0.614-0.782]), and in surgical cases, the discrimination ability is good (AUC-ROC 95% CI: 0.848 [0.776-0.921]). Both cases showed good calibration (p: medical = 0.569, surgical = 0.579) in predicting mortality during the pandemic. Conclusion: APACHE IV showed good discrimination but poor calibration ability for predicting mortality for all ICU patients during the pandemic era. Mortality prediction for surgical cases showed good discrimination and calibration. However, medical cases showed poor discrimination but good calibration.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127569086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.20473/ijar.v5i12023.27-36
Herlina Rahmah, A. Adisasmita, S. Manggala, A. Sugiarto, Fadiah Zahrina, Prita Rosdiana
Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Materials and Methods: This research is a cohort retrospective study that analyzed 171 patients aged ≥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p <0.05). The increased risk of PIH associated with high SI score was an aRR of 1.9; 95% CI 1.03–3.57, a p-value of 0.040 among those with sepsis, and an aRR of 7.9, 95% CI 2.36–26.38, a p-value of 0.001 among those without sepsis. Conclusion: This study showed that a high SI score was associated with PIH after being controlled with other PIH risk variables. The risk of PIH associated with SI score modestly increased (2-fold increase) in those with sepsis and significantly increased (8-fold increase) in those without sepsis.
简介:低血压是紧急气管插管(ETI)后的急性并发症，在呼叫快速反应小组(RRT)的人群中。因此，需要一种快速而简单的工具来识别急诊后插管低血压(PIH)的风险。插管前休克指数(SI)是预测PIH的潜在因素之一。目的:探讨休克指数与呼入RRT后急诊插管低血压的关系。材料和方法:本研究是一项队列回顾性研究，分析了171例年龄≥18岁的RRT和急诊ETI患者。用ROC曲线预测PIH，确定SI的分界点。采用分层分析法评价改性效果。使用cox回归分析数据，以确定SI在低血压原因中的可能性。结果:92例患者(53.8%)急诊后插管降压。SI截断点为0.9，预测PIH的敏感性为82.6%，特异性为67.1%(曲线下面积(AUC) 0.81;95% CI 0.754 ~ 0.882, p <0.05)。高SI评分与PIH风险增加相关的aRR为1.9;脓毒症患者的95% CI为1.03-3.57,p值为0.040;无脓毒症患者的aRR为7.9,95% CI为2.36-26.38,p值为0.001。结论:本研究表明，在与其他PIH风险变量控制后，高SI评分与PIH相关。脓毒症患者与SI评分相关的PIH风险适度增加(增加2倍)，无脓毒症患者的PIH风险显著增加(增加8倍)。
{"title":"Association Between Shock Index and Post-Emergency Intubation Hypotension in Patients Who Called the Rapid Response Team at Dr. Cipto Mangunkusumo Hospital","authors":"Herlina Rahmah, A. Adisasmita, S. Manggala, A. Sugiarto, Fadiah Zahrina, Prita Rosdiana","doi":"10.20473/ijar.v5i12023.27-36","DOIUrl":"https://doi.org/10.20473/ijar.v5i12023.27-36","url":null,"abstract":"Introduction: Hypotension is an acute complication following Emergency Endotracheal Intubation (ETI) in populations who called the Rapid Response Team (RRT). Thus, a fast and simple tool is needed to identify the risk of Post-emergency Intubation Hypotension (PIH). Shock Index (SI) pre-intubation is one of the potential factors to predict PIH. Objective: To measure the association between shock index with post-emergency intubation hypotension after calling for the RRT. Materials and Methods: This research is a cohort retrospective study that analyzed 171 patients aged ≥18 years who have called RRT and underwent an emergency ETI. The cut-off point for SI was determined using the ROC curve to predict PIH. The modification effect was evaluated using stratification analysis. Data were analyzed using cox regression to determine the likelihood of SI in the cause of hypotension. Result: A total of 92 patients (53.8%) underwent post-emergency intubation hypotension. The SI cut-off point of 0.9 had a sensitivity of 82.6% and a specificity of 67.1% for predicting PIH (Area Under Curve (AUC) 0.81; 95% CI 0.754–0.882, p <0.05). The increased risk of PIH associated with high SI score was an aRR of 1.9; 95% CI 1.03–3.57, a p-value of 0.040 among those with sepsis, and an aRR of 7.9, 95% CI 2.36–26.38, a p-value of 0.001 among those without sepsis. Conclusion: This study showed that a high SI score was associated with PIH after being controlled with other PIH risk variables. The risk of PIH associated with SI score modestly increased (2-fold increase) in those with sepsis and significantly increased (8-fold increase) in those without sepsis.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"215 S681","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120852138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.20473/ijar.v5i12023.45-50
Mirza Koeshardiandi, Muhammad Wildan Afif Himawan, Fajar Perdhana, Zulfikar Loka Wicaksana
Introduction: Heart disease is one of the most common causes of maternal death. The incidence has increased since women with congenital and acquired heart disease reached fertile age. The circulation system changes during pregnancy which are induced by changes in the progesterone. The changes in progesterone levels increase heart work and cause death in pregnant women. Objective: This report aims to elaborate on the administration of nitrates as the management of labor in rheumatic heart disease (RHD). Case Report: A 27-year-old woman complained of shortness of breath and wanted to give birth. The patient was 38 weeks pregnant and had a history of heart disease. Antero-posterior chest radiography examination showed pulmonary edema and cardiomegaly. The patient was examined using echocardiography before spontaneous labor and was diagnosed as pregnant with rheumatic heart disease. As an emergency management, the patient was given painless spontaneous labor. The patient was given nitrates on the first day after delivery as a treatment for progesterone withdrawal syndrome in this case. After the delivery process was completed, the patient was admitted to the Intensive Care Unit (ICU). Discussion: Progesterone hormone produced by the corpus luteum and the placenta until the eighth week of pregnancy and before delivery, respectively, can reduce systemic vascular resistance. Progesterone hormone increase causes peripheral vasodilation by affecting the function of endothelial nitric oxide synthase (eNOS) and nitrite oxide (NO) production. Conclusion: A pregnant woman with rheumatic heart disease can be given exogenous nitrate. Administration of exogenous nitrates in this patient successfully prevent the reduction of peripheral vascular resistance and postpartum hemodynamic instability because it can replace the reduction in nitric oxide caused by progesterone withdrawal.
{"title":"Administration of Nitrates After Spontaneous Delivery in Rheumatic Heart Disease","authors":"Mirza Koeshardiandi, Muhammad Wildan Afif Himawan, Fajar Perdhana, Zulfikar Loka Wicaksana","doi":"10.20473/ijar.v5i12023.45-50","DOIUrl":"https://doi.org/10.20473/ijar.v5i12023.45-50","url":null,"abstract":"Introduction: Heart disease is one of the most common causes of maternal death. The incidence has increased since women with congenital and acquired heart disease reached fertile age. The circulation system changes during pregnancy which are induced by changes in the progesterone. The changes in progesterone levels increase heart work and cause death in pregnant women. Objective: This report aims to elaborate on the administration of nitrates as the management of labor in rheumatic heart disease (RHD). Case Report: A 27-year-old woman complained of shortness of breath and wanted to give birth. The patient was 38 weeks pregnant and had a history of heart disease. Antero-posterior chest radiography examination showed pulmonary edema and cardiomegaly. The patient was examined using echocardiography before spontaneous labor and was diagnosed as pregnant with rheumatic heart disease. As an emergency management, the patient was given painless spontaneous labor. The patient was given nitrates on the first day after delivery as a treatment for progesterone withdrawal syndrome in this case. After the delivery process was completed, the patient was admitted to the Intensive Care Unit (ICU). Discussion: Progesterone hormone produced by the corpus luteum and the placenta until the eighth week of pregnancy and before delivery, respectively, can reduce systemic vascular resistance. Progesterone hormone increase causes peripheral vasodilation by affecting the function of endothelial nitric oxide synthase (eNOS) and nitrite oxide (NO) production. Conclusion: A pregnant woman with rheumatic heart disease can be given exogenous nitrate. Administration of exogenous nitrates in this patient successfully prevent the reduction of peripheral vascular resistance and postpartum hemodynamic instability because it can replace the reduction in nitric oxide caused by progesterone withdrawal.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115976997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.20473/ijar.v5i12023.18-26
Rifdhani Fakhrudin Nur, Erlangga Prasamya, Arief Ikhwandi, P. Utomo, Sudadi
Introduction: Basic Life Support (BLS) training during the COVID-19 pandemic needed to be effective as well as prevent disease transmission between trainers and participants. The distance-learning method is one of the recommended modified training methods. However, there is still limited research that evaluates the effectiveness of the distance-learning method for BLS training for laypersons during the COVID-19 pandemic. Objective: To evaluate the effectiveness and retention of the distance-learning method for BLS training in improving the participant’s knowledge and skills. Materials and Methods: This is a non-randomized quasi-experimental study (one group pre-test and post-test design). A total of 64 TAGANA (Taruna Siaga Bencana/disaster volunteer) members of Sleman Regency who had undergone the distance learning method for BLS training were the participants of this study. A knowledge questionnaire and observation checklist were prepared and tested for context validity by an expert group. Data on the participant’s knowledge were collected before and after the training session, and data on the participant’s skills were recorded after the training session. After the training, a social media group was created to provide a periodical refresher of the BLS materials and facilitate discussions between the speakers and the study’s samples. Data on knowledge retention and skills were recorded six months post-training. Results: The distance-learning method for BLS training effectively increased the participants' knowledge of BLS, indicated by a significantly higher final knowledge score than before the training (Z=-6.904, p <0.001). The method also provided sufficient BLS skills, indicated by most of the samples (93.7%) passing the skill observation test even though no participant had attended a similar training before. Moreover, the participant’s knowledge and skills scores were significantly lower six months after the training session than immediately after training (Z=-5.157, p <0.001; Z=-4.219, p <0.001). Conclusion: The distance-learning method for BLS training effectively increased the participant’s BLS knowledge and skills. However, their knowledge and skills decreased at six months post-training. Overall, the distance-learning method has been proven as a promising alternative to BLS training during and after the COVID-19 pandemic.
导言:COVID-19大流行期间的基本生命支持(BLS)培训需要有效，并防止培训人员和参与者之间的疾病传播。远程学习方法是一种被推荐的改良训练方法。然而，在COVID-19大流行期间，评估远程学习方法对非专业人员进行劳工统计局培训的有效性的研究仍然有限。目的:评价远程学习方法在劳工统计局培训中提高被试知识和技能的有效性和保持性。材料与方法:本研究为非随机准实验研究(一组前测和后测设计)。本研究以64名接受过BLS远程学习培训的Sleman Regency的TAGANA (Taruna Siaga benana /disaster volunteer)成员为研究对象。准备了知识问卷和观察清单，并由专家组进行了上下文效度测试。在培训之前和之后收集参与者的知识数据，在培训之后记录参与者的技能数据。培训结束后，成立了一个社交媒体小组，定期更新劳工统计局的材料，并促进演讲者与研究样本之间的讨论。培训后6个月记录知识保留和技能的数据。结果:远程学习方式的BLS训练有效提高了被试对BLS的知识，最终知识得分显著高于训练前(Z=-6.904, p <0.001)。该方法还提供了足够的劳工统计局技能，大多数样本(93.7%)通过了技能观察测试，即使参与者之前没有参加过类似的培训。此外，参与者的知识和技能得分在培训后6个月显著低于培训后立即(Z=-5.157, p <0.001;Z=-4.219, p <0.001)。结论:远程学习方式的劳工统计局培训有效地提高了被试的劳工统计局知识和技能。然而，他们的知识和技能在培训后六个月有所下降。总体而言，在2019冠状病毒病大流行期间和之后，远程学习方法已被证明是一种有希望的替代劳工统计局培训的方法。
{"title":"Basic Life Support Training: The Effectiveness and Retention of The Distance-Learning Method","authors":"Rifdhani Fakhrudin Nur, Erlangga Prasamya, Arief Ikhwandi, P. Utomo, Sudadi","doi":"10.20473/ijar.v5i12023.18-26","DOIUrl":"https://doi.org/10.20473/ijar.v5i12023.18-26","url":null,"abstract":"Introduction: Basic Life Support (BLS) training during the COVID-19 pandemic needed to be effective as well as prevent disease transmission between trainers and participants. The distance-learning method is one of the recommended modified training methods. However, there is still limited research that evaluates the effectiveness of the distance-learning method for BLS training for laypersons during the COVID-19 pandemic. Objective: To evaluate the effectiveness and retention of the distance-learning method for BLS training in improving the participant’s knowledge and skills. Materials and Methods: This is a non-randomized quasi-experimental study (one group pre-test and post-test design). A total of 64 TAGANA (Taruna Siaga Bencana/disaster volunteer) members of Sleman Regency who had undergone the distance learning method for BLS training were the participants of this study. A knowledge questionnaire and observation checklist were prepared and tested for context validity by an expert group. Data on the participant’s knowledge were collected before and after the training session, and data on the participant’s skills were recorded after the training session. After the training, a social media group was created to provide a periodical refresher of the BLS materials and facilitate discussions between the speakers and the study’s samples. Data on knowledge retention and skills were recorded six months post-training. Results: The distance-learning method for BLS training effectively increased the participants' knowledge of BLS, indicated by a significantly higher final knowledge score than before the training (Z=-6.904, p <0.001). The method also provided sufficient BLS skills, indicated by most of the samples (93.7%) passing the skill observation test even though no participant had attended a similar training before. Moreover, the participant’s knowledge and skills scores were significantly lower six months after the training session than immediately after training (Z=-5.157, p <0.001; Z=-4.219, p <0.001). Conclusion: The distance-learning method for BLS training effectively increased the participant’s BLS knowledge and skills. However, their knowledge and skills decreased at six months post-training. Overall, the distance-learning method has been proven as a promising alternative to BLS training during and after the COVID-19 pandemic.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133450789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.20473/ijar.v5i12023.51-63
Eko Setijanto, Kiel Pino Putra
Introduction: Scoliosis is a three-dimensional spinal deformity that is mainly determined based on the lateral curvature of the spine. Furthermore, regional anesthesia often infiltrates the peripheral nerves with an anesthetic agent and blocks transmission to avoid or relieve pain. A previous study revealed that scoliosis in patients is one of the factors affecting the success of spinal anesthesia. Objective: To obtain a theoretical basis that can support the solution to the RASAB problem. The acceptance of the theory is the first step to providing a better understanding of the study problem based on the scientific framework of thinking. Furthermore, the similarities, differences, and views of several pieces of literature that discussed related issues were evaluated in this review. Review: Regional anesthesia subarachnoid blockade (RASAB) or spinal anesthesia, is a procedure, which involves the administration of local anesthetic drugs into the subarachnoid space. Furthermore, the process is carried out between the lumbar (L) vertebrae L2-L3, L3-L4, or L4-L5. Spinal anesthesia is often used in surgical procedures involving the lower abdomen, pelvis, perineum, and lower extremities. Summary: In the setting of scoliosis, spinal anesthesia is challenging, but is not an absolute contraindication. Patients with scoliosis have unique characteristics, hence, anesthetists need to understand the impact of the disease on the body.
{"title":"Regional Anesthesia Subarachnoid Blockade (RASAB) in Scoliosis Patients","authors":"Eko Setijanto, Kiel Pino Putra","doi":"10.20473/ijar.v5i12023.51-63","DOIUrl":"https://doi.org/10.20473/ijar.v5i12023.51-63","url":null,"abstract":"Introduction: Scoliosis is a three-dimensional spinal deformity that is mainly determined based on the lateral curvature of the spine. Furthermore, regional anesthesia often infiltrates the peripheral nerves with an anesthetic agent and blocks transmission to avoid or relieve pain. A previous study revealed that scoliosis in patients is one of the factors affecting the success of spinal anesthesia. Objective: To obtain a theoretical basis that can support the solution to the RASAB problem. The acceptance of the theory is the first step to providing a better understanding of the study problem based on the scientific framework of thinking. Furthermore, the similarities, differences, and views of several pieces of literature that discussed related issues were evaluated in this review. Review: Regional anesthesia subarachnoid blockade (RASAB) or spinal anesthesia, is a procedure, which involves the administration of local anesthetic drugs into the subarachnoid space. Furthermore, the process is carried out between the lumbar (L) vertebrae L2-L3, L3-L4, or L4-L5. Spinal anesthesia is often used in surgical procedures involving the lower abdomen, pelvis, perineum, and lower extremities. Summary: In the setting of scoliosis, spinal anesthesia is challenging, but is not an absolute contraindication. Patients with scoliosis have unique characteristics, hence, anesthetists need to understand the impact of the disease on the body.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133420049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.20473/ijar.v5i12023.1-10
Almira Saskia Sabila, Maulydia, Betty Agustina Tambunan, Edward Kusuma
Introduction: Blood transfusion is the process of transferring blood or its components, such as red blood cells, plasma, and platelets, from donor to recipient. The major reason for blood transfusion is anemia and bleeding, frequently seen in critically ill trauma patients in Intensive Observation Unit (Ruang Observasi Intensif/ROI). One of the most prevalent causes of potentially preventable death in trauma patients is uncontrolled bleeding. In addition to controlling the bleeding by surgical or interventional procedures, blood transfusion is carried out to maintain oxygenation to tissue, preventing organ dysfunction due to hypoxia. Objective: This study aimed to determine the profile of blood transfusion carried out on the patients in the ROI of Dr. Soetomo General Academic Hospital. Materials and Methods: This retrospective descriptive study was conducted using medical records involving 258 patients who met the inclusion criteria. Results: The result showed that the majority of patients were female, aged 26-35 years, had blood type O, and Rhesus (Rh)-positive, accounting for 55.04%, 26.36%, 39.53%, and 100%, respectively. The most common indication for transfusion was anemia, with a percentage of 69.10%, particularly severe anemia, accounting for 48.45%. Furthermore, 57.36% of patients were from the surgery department, and 36.05% stayed in ROI for 2-3 days. The most common blood component and unit transfused was packed red blood cells (PRC), with a percentage of 57.50% and 439 units at 47.82%. Most of the transfusions, with a percentage of 37.80%, were carried out within 3-4 hours. Some patients were experiencing pruritus, febrile, urticaria, and chills, accounting for 0.39%, 0.39%, 0.39%, and 0.39%, respectively. Conclusion: Understanding transfusion practices, including blood type distribution, can prevent blood shortage, estimate the need for blood among ROI patients in Dr. Soetomo General Academic Hospital, and further ensure that all transfusions are ABO and Rh compatible.
{"title":"Blood Transfusion Practices at The Intensive Observation Unit (Ruang Observasi Intensif/ROI) of Dr. Soetomo General Academic Hospital Surabaya","authors":"Almira Saskia Sabila, Maulydia, Betty Agustina Tambunan, Edward Kusuma","doi":"10.20473/ijar.v5i12023.1-10","DOIUrl":"https://doi.org/10.20473/ijar.v5i12023.1-10","url":null,"abstract":"Introduction: Blood transfusion is the process of transferring blood or its components, such as red blood cells, plasma, and platelets, from donor to recipient. The major reason for blood transfusion is anemia and bleeding, frequently seen in critically ill trauma patients in Intensive Observation Unit (Ruang Observasi Intensif/ROI). One of the most prevalent causes of potentially preventable death in trauma patients is uncontrolled bleeding. In addition to controlling the bleeding by surgical or interventional procedures, blood transfusion is carried out to maintain oxygenation to tissue, preventing organ dysfunction due to hypoxia. Objective: This study aimed to determine the profile of blood transfusion carried out on the patients in the ROI of Dr. Soetomo General Academic Hospital. Materials and Methods: This retrospective descriptive study was conducted using medical records involving 258 patients who met the inclusion criteria. Results: The result showed that the majority of patients were female, aged 26-35 years, had blood type O, and Rhesus (Rh)-positive, accounting for 55.04%, 26.36%, 39.53%, and 100%, respectively. The most common indication for transfusion was anemia, with a percentage of 69.10%, particularly severe anemia, accounting for 48.45%. Furthermore, 57.36% of patients were from the surgery department, and 36.05% stayed in ROI for 2-3 days. The most common blood component and unit transfused was packed red blood cells (PRC), with a percentage of 57.50% and 439 units at 47.82%. Most of the transfusions, with a percentage of 37.80%, were carried out within 3-4 hours. Some patients were experiencing pruritus, febrile, urticaria, and chills, accounting for 0.39%, 0.39%, 0.39%, and 0.39%, respectively. Conclusion: Understanding transfusion practices, including blood type distribution, can prevent blood shortage, estimate the need for blood among ROI patients in Dr. Soetomo General Academic Hospital, and further ensure that all transfusions are ABO and Rh compatible.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123069165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.20473/ijar.v5i12023.11-17
Rafida Anshori, A. Setyaningtyas, Arie Utariani, N. P. Kusumastuti
Introduction: Shock is a life-threatening condition caused by circulatory failure which increases morbidity and mortality rate. According to the western literature, about 2% of children are admitted to hospitals worldwide due to shock. Objective: This study aimed to describe the pediatric shock profile of patients in the Pediatric Intensive Care Unit (PICU) of Dr. Soetomo General Academic Hospital between 1 January to 1 December 2019. Materials and Methods: A total of 60 patients were selected as the participants using a descriptive method. Data collection was carried out by recording the exact time the participants first entered the PICU. Furthermore, data were collected based on gender, age, physical and laboratory examination, diagnosis of shock, patients’ outcomes, as well as PRISM III score. Results: The results of this study that the males and children are 51.7% and 53.3%, respectively. At an infant age, the distribution of the highest average pulse and breathing frequency was 135 and 32.2, respectively. The highest average body temperature at the age of adolescents was 37.19°C. Furthermore, the patients' diagnoses were dominated by distributive shock with the highest PRISM III score ≥8 and deaths recorded of 76.6%, 60%, and 61.7%, respectively. The diagnosis results showed that distributive shock leads to the highest mortality with a PRISM III score of 51.7% and 53.3%. Conclusion: Distributive shock contributes to the patient's diagnoses and mortality rate with the highest score of PRISM III being ≥8. From this conclusion, the PICU needs to be more responsive to detect distributive shock in children.
{"title":"Pediatric Shock Profile in The Pediatric Intensive Care Unit (PICU) of Dr. Soetomo General Academic Hospital","authors":"Rafida Anshori, A. Setyaningtyas, Arie Utariani, N. P. Kusumastuti","doi":"10.20473/ijar.v5i12023.11-17","DOIUrl":"https://doi.org/10.20473/ijar.v5i12023.11-17","url":null,"abstract":"Introduction: Shock is a life-threatening condition caused by circulatory failure which increases morbidity and mortality rate. According to the western literature, about 2% of children are admitted to hospitals worldwide due to shock. Objective: This study aimed to describe the pediatric shock profile of patients in the Pediatric Intensive Care Unit (PICU) of Dr. Soetomo General Academic Hospital between 1 January to 1 December 2019. Materials and Methods: A total of 60 patients were selected as the participants using a descriptive method. Data collection was carried out by recording the exact time the participants first entered the PICU. Furthermore, data were collected based on gender, age, physical and laboratory examination, diagnosis of shock, patients’ outcomes, as well as PRISM III score. Results: The results of this study that the males and children are 51.7% and 53.3%, respectively. At an infant age, the distribution of the highest average pulse and breathing frequency was 135 and 32.2, respectively. The highest average body temperature at the age of adolescents was 37.19°C. Furthermore, the patients' diagnoses were dominated by distributive shock with the highest PRISM III score ≥8 and deaths recorded of 76.6%, 60%, and 61.7%, respectively. The diagnosis results showed that distributive shock leads to the highest mortality with a PRISM III score of 51.7% and 53.3%. Conclusion: Distributive shock contributes to the patient's diagnoses and mortality rate with the highest score of PRISM III being ≥8. From this conclusion, the PICU needs to be more responsive to detect distributive shock in children.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130959935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.20473/ijar.v5i12023.37-44
I. Wijaya, Mahmud
Introduction: Breakthrough Pain (BTP) is experienced as mild to moderate-severe pain, from only a few seconds to hours. It causes a decrease in the quality of life and functional capacities. Furthermore, BPT must be recognizable, assessed, and controlled to prevent its relapse and severity. Case report: A woman, 45 years old, having breast cancer along with pulmonary, femur, and cervical metastases, came with the main complaint of pain. The patient had a pain score of NRS 9, which was felt intermittently for the last 3 months. Treatment has been carried out with MST 10 mg/8 hours and a Durogesic® patch (fentanyl 50 mcg/h) but the pain did not subside. Moreover, the patient was unable to identify any precipitating factors or pain relievers, while the diagnosis confirmed BTP. The rescue dose was administered in a range of 10 – 20% of the total daily dose in the last 24 hours equivalent to 11 – 22 mg intravenous Morphine or equianalgesic with 110 – 220 mcg of fentanyl. For immediate effect, transmucosal fentanyl was recommended, but this preparation is currently unavailable. Moreover, therapy was carried out with the continuous administration of Morphine, and the pain reduced to NRS 0 – 3 on the second day. Conclusion: Transmucosal fentanyl, either buccal, sublingual, oral, or nasal mucosa, was proven to be effective in treating BTP. However, when transmucosal fentanyl is not available, multimodal analgesia is an effective alternative.
{"title":"Using Multimodal Analgesia for Breakthrough Pain in Stage IV Breast Cancer Patient","authors":"I. Wijaya, Mahmud","doi":"10.20473/ijar.v5i12023.37-44","DOIUrl":"https://doi.org/10.20473/ijar.v5i12023.37-44","url":null,"abstract":"Introduction: Breakthrough Pain (BTP) is experienced as mild to moderate-severe pain, from only a few seconds to hours. It causes a decrease in the quality of life and functional capacities. Furthermore, BPT must be recognizable, assessed, and controlled to prevent its relapse and severity. Case report: A woman, 45 years old, having breast cancer along with pulmonary, femur, and cervical metastases, came with the main complaint of pain. The patient had a pain score of NRS 9, which was felt intermittently for the last 3 months. Treatment has been carried out with MST 10 mg/8 hours and a Durogesic® patch (fentanyl 50 mcg/h) but the pain did not subside. Moreover, the patient was unable to identify any precipitating factors or pain relievers, while the diagnosis confirmed BTP. The rescue dose was administered in a range of 10 – 20% of the total daily dose in the last 24 hours equivalent to 11 – 22 mg intravenous Morphine or equianalgesic with 110 – 220 mcg of fentanyl. For immediate effect, transmucosal fentanyl was recommended, but this preparation is currently unavailable. Moreover, therapy was carried out with the continuous administration of Morphine, and the pain reduced to NRS 0 – 3 on the second day. Conclusion: Transmucosal fentanyl, either buccal, sublingual, oral, or nasal mucosa, was proven to be effective in treating BTP. However, when transmucosal fentanyl is not available, multimodal analgesia is an effective alternative.","PeriodicalId":117902,"journal":{"name":"Indonesian Journal of Anesthesiology and Reanimation","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134583406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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