Pertin Sianturi

Comparison of ventilation parameters and blood gas analysis in mechanically-ventilated children who received chest physiotherapy and suctioning vs. suctioning alone

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 parameters and BGA. 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 mechanically-ventilated 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 cmH 2 O, respectively; P=0.23). The BGA values were: median pH (7.4 vs. 7.3, respectively; P=0.838), median pCO 2 (38.4 vs . 36.2 mmHg, respectively; P=1.000), mean pO 2 (136.6 vs. 139.2 mmHg, respectively; P=0.834), median HCO 3 (20.4 vs. 22.7 mmol/L, respectively; P=0.594), median TCO 2 (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 O 2 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 different between subjects who received both chest physiotherapy and suctioning and those who received suctioning alone.

Rasio Bilirubin Albumin pada Neonatus dengan Hiperbilirubinemia

Latar belakang. Bilirubin tidak terikat potensial membahayakan sistem susunan saraf pusat, dan dapat menyebabkan kerusakan neurologis yang berat dan permanen.Rasio total bilirubin dan albumin dianggap parameter mewakili bilirubin yang tidak terikat,dalam menentukan modalitas terapi untuk hiperbilirubinemia. Tujuan. Mengetahui rasio bilirubin albumin pada pasien hiperbilirubinemia. Metode .Penelitian menggunakan studi sekat lintang yang dilakukan di Divisi Neonatologi RS. H. Adam Malik Medan dan RS. Pirngadi Medan mulai Agustus 2009 – Maret 2010. Hasil. Terdapat hubungan yang bermakna antara kadar albumin dan toral serum bilirubin dengan p<0,05. Kesimpulan. Rasio bilirubin-albumin merupakan parameter jumlah bilirubin bebas, dan dapat digunakan sebagai indikator yang lebih baik dalam penentuan terapi, untuk menurunkan kejadian bilirubin-induced neurologic damage.