Background One of the diagnostic criteria for acute lung injury (ALI) is the PaO2/FiO2 (P/F) ratio. This measurement is obtained by blood gas analysis, which involves an invasive procedure (arterial blood draw). In order to reduce invasive procedures on critically ill patients, an alternative non-invasive marker for ALI is needed. The SpO2/FiO2 (S/F) ratio attained by pulse oximetry may be a suitable alternative.Objective To investigate for a correlation between S/F ratio and P/F ratio, in order to find an alternative non-invasive marker of ALI.Methods A cross-sectional study was conducted in the pediatric intensive care unit (PICU) at Haji Adam Malik Hospital, Medan from August 2012 to June 2013. Subjects (children aged 1 month – 18 years) underwent blood gas analysis when their pulse oximetry showed saturation of 80-97% within 24 hours of ventilator use. We measured PaO2, SpO2, and FiO2 and calculated S/F and P/F ratios. Data were analyzed by Spearman’s correlation and linear regression tests.Results Of 69 PICU patients, 39 children fulfilled the criteria for ALI. The S/F ratio and P/F ratio had a weak correlation (r=0.2; P=0.18). The linear regression equation was S/F ratio = 129.67 + 0.11 (P/F), with S/F ratio values of 162.67 and 151.67 correlating to P/F ratio values of 300 and 200, respectively.Conclusion The S/F ratio has a weak correlation with P/F ratio for ALI in children.
Background Chest physiotherapy and suctioning are routine methods for airway clearance in mechanically-ventilated children. However, chest physiotherapy has not been confirmed to affect ventilation parameters, such as tidal volume (TV), peak inflation pressure (pIp), peak inspiratory flow (pIF), and peak expiratory flow (pEF), as well as blood gas analysis (BGA) values in pediatric intensive care unit (pICU) patients. Objective To determine the efficacy of chest physiotherapy and suctioning vs. suctioning alone for improving the mechanical ventilation and BGA parameters. Methods This randomized, single-blind, clinical trial was conducted from November 2012 to June 2013 in the pICU at Haji Adam Malik Hospital, Medan. A total of 40 mechanicallyventilated pediatric patients were enrolled and divided into either the chest physiotherapy and suctioning group (24 subjects) or the suctioning alone group (16 subjects). Subjects underwent treatment, followed by monitoring of their ventilation parameters and blood gas analyses. Data were analyzed by independent T-test and Mann-Whitney test. Results Subjects comprised of 23 boys and 17 girls, with an age range of 1-204 months. After the respective treatments (chest physiotherapy and suctioning vs. suctioning alone), the ventilation parameters were as follows: median TV (60.0 vs. 56.5 mL, respectively; p=0.838), median pEF (10.4 vs. 10.8 I/s, respectively; p=0.838), median pIF (7.4 vs. 8.2 I/s, respectively; p=0.469), and mean pIp (17.3 vs. 15.6 cmH2O, respectively; p=0.23). The BGA values were: median pH (7.4 vs. 7.3, respectively; p=0.838), median pCO2 (38.4 vs. 36.2 mmHg, respectively; p=1.000), mean pO2 (136.6 vs. 139.2 mmHg, respectively; p=0.834), median HCO3 (20.4 vs. 22.7 mmol/L, respectively; p=0.594), median TCO2 (22.0 vs. 23.7 mmol/L, respectively; p=0.672), mean BE (-4.3 vs. -3.1 mmol/L, respectively; p=0.629), and median O2 saturation (98.5 vs. 98.3 %, respectively; p=0.967). Conclusion In mechanically-ventilated children in the pICU, ventilation parameters and BGA values are not significantly
BACKGROUND: Sepsis is a significant cause of morbidity and mortality in children. The diagnosis of sepsis remains continuing to develop which determines treatment and prognostic. Antithrombin III is one of the coagulation markers to evaluate the prognosis of sepsis. AIM: To determine the association between the level of antithrombin III and mortality in children with sepsis in the Pediatric Intensive Care Unit, Haji Adam Malik General Hospital, Medan. METHODS: A cross-sectional study was conducted in Haji Adam Malik General Hospital, Medan from April until June 2015. There were 41 children with sepsis. Sepsis was diagnosed from clinical and laboratory findings. Complete blood count, antithrombin III level, C-reactive protein and procalcitonin were an indicator of unproven sepsis that performed in the laboratory. Meanwhile blood culture was performed in the microbiology laboratory. The association between the level of antithrombin III and mortality was analysed by using chi-square test. RESULTS: Of the 41 participants, the low antithrombin III level was 13 of 41 children (31.7%) meanwhile the normal antithrombin III level was 28 of 41 children (68.3%). There was 8 of 13 (42.1%) and 11 of 28 (57.9%) children in death cases of low and normal antithrombin III level, respectively. Samples with low antithrombin III level had 2.473 higher risk mortality than normal antithrombin III level (P = 0.184; 95% CI 0.641 to 9.5421; PR = 2.473). CONCLUSION: There was no statistically significant association between levels of antithrombin III and mortality in children with sepsis.
Latar belakang. Sepsis merupakan penyebab tersering morbiditas dan mortalitas pada anak. Vitamin D memiliki peran penting dalam mengoptimalkan sistem imun bawaan serta memodulasi respon imun adaptif pada sepsis. Tujuan. Untuk mengevaluasi nilai diagnostik dari kadar 25-hydroxyvitamin D sebagai penanda sepsis pada anak. Metode. Penelitian diagnostik dengan desain potong lintang dilakukan terhadap 50 anak di PICU RSUP Haji Adam Malik dari Februari sampai Maret 2016. Duapuluh lima anak didiagnosis sepsis dan 25 non sepsis. Kriteria inklusi adalah pasien anak berusia 1 bulan sampai <18 tahun. Sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif, rasio kemungkinan positif dan negatif dinilai pada penelitian ini. Hasil. Rerata kadar 25-hydroxyvitamin D pada kelompok sepsis (24 ng/mL) relatif lebih rendah dibandingkan dengan kelompok non sepsis (29,7 ng/mL). Nilai batas ambang kadar 25-hydroxyvitamin D 24 ng/mL. Kami menemukan 15 orang dengan sepsis dan 2 orang non sepsis dengan nilai batas ambang ini. Dari uji diagnostik diperoleh sensitivitas 60%, spesifisitas 92%, nilai duga positif 88%, nilai duga negatif 70%, rasio kemungkinan positif 7,5 dan rasio kemungkinan negatif 0,43. 25-Hydroxyvitamin D Level as a Marker of Sepsis in ChildrenAustin Simon Tjowanta, Chairul Yoel, Munar Lubis Background. Sepsis is the major cause of morbidity and mortality among children. Vitamin D plays an important roles in optimazing the innate immune system and the adaptive immune response in sepsis. Objective. To evaluate diagnostic values of 25-hydroxyvitamin D level as a marker for sepsis in children. Methods. A diagnostic study with cross-sectional design was conducted in 50 children, 25 with sepsis and 25 without sepsis in the PICU, Haji Adam Malik Hospital from February to March 2016. Children aged 1 month to <18 years were included. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were evaluated in this study. Results. The mean level of 25-hydroxyvitamin D in the sepsis group (24 ng/mL) was lower than in the non-sepsis group (29.7 ng/ mL). The 25-hydroxyvitamin D level had a cut-off point of 24 ng/mL. Using this cut-off point, we identified 15 patients with sepsis and 2 patients without sepsis. The diagnostic study showed 60% sensitivity, 92% specificity, 88% positive predictive value, 70% negative predictive value, 7.5 positive likelihood ratio, and 0.43 negative likelihood ratio. Conclusion. The 25-hydroxyvitamin D level has high specificity but low sensitivity, for it can be used as additional sepsis marker in children. Sari Pediatri 2017;19(3):150-5
Latar belakang. Glukosa sumber energi untuk latihan fisik dan berpengaruh pada keseimbangan metabolisme tubuh. Glukosa menyebabkan masuknya ion natrium ke dalam sel. Sewaktu ATP terhidrolisis menjadi ADP, protein pembawa mengalami fosforilasi dan perubahan konformasi yang menyebabkan ion natrium dilepaskan ke cairan ekstrasel. Kemudian dua ion kalium berikatan di sisi ekstrasel masuk ke sel.Tujuan. Untuk mengetahui dan membandingkan perubahan kadar natrium dan kalium serum sebelum dan setelah latihan fisik akut pada kelompok yang diberikan air putih dan air berglukosa 40%.Metode. Empat puluh anak SLTP sehat yang dipilih secara acak sederhana mendapat minuman glukosa 40% (dosis 1 g/kgBB yang dilarutkan dalam 300cc air) (n=20) dan air putih sebanyak 300 cc (n=20). Semua anak diberi minum 10 menit sebelum latihan fisik, kemudian dilakukan latihan fisik selama 10 menit. Sampel darah vena diambil sebelum anak minum dan setelah melakukan latihan fisik.Hasil. Terjadi perubahan penurunan natrium serum berbeda bermakna setelah latihan fisik akut (p<0,05) pada kelompok air putih, sedangkan pada kelompok air berglukosa 40% terjadi peningkatan natrium serum. Perbandingan kadar natrium serum kedua kelompok berbeda bermakna (p<0,05). Kadar kalium serum tidak mengalami perubahan (p>0,05) pada kedua kelompok.Kesimpulan. �� � � � � � � ��� � � � � � -Pemberian minuman berglukosa 40% sebelum latihan fisik akut dapat menyebabkan peningkatan kadar natrium serum.
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