Background: Patients aided by mechanical ventilator are associated with critical illness bearing high mortality rate. Knowledge about predictors of mortality helps in clinical decision regarding the management and prognosis. To date there has been no comprehensive study about the predictors of mortality in patients with mechanical ventilator in Indonesia. Objective: To acknowledge the predictors of mortality in patients with mechanical ventilator in Cipto Mangunkusumo Hospital, Jakarta.
Methods: This retrospective cohort includes patients aided by mechanical ventilator in the Intensive Care Unit (ICU) of Cipto Mangunkusumo Hospital during 2010-2012. Clinical data and laboratory results as well as clinical outcome (survival or death) were obtained from medical records. Bivariate analysis was conducted to variables age, malignancies, acute respiratory distress syndrome (ARDS), shock, post-operative state, history of cardiac arrest, hyperglycemia, stroke, acute kidney injury, sepsis and hypoalbuminemia. Variables which made the cut were included in multivariate analysis with logistic regression.
Results: The study involved 242 patients with mortality rate of 45.4%. Age, malignancies, ARDS, shock, post-operative state, history of cardiac arrest, stroke, acute kidney injury, sepsis and hypoalbuminemia show statistical difference in bivariate analysis. Multivariate analysis gathers these predictors of mortality: acute kidney injury (OR 1,91; CI95% 1,08-3,39; p=0,002), shock (OR 2,13; CI95% 1,18-3,85; p=0,012), stroke (OR 3,39; CI95% 1,65-6,95; p=0,01), ARDS (OR 2,19; CI95% 1,10-4,35; p=0,025) and history of cardiac arrest (OR 4,85; CI95% 1,56-15,07; p=0,006). Conclusions: Acute kidney injury, shock, stroke, ARDS and history of cardiac arrest are independent predictors of mortality in patients aided by mechanical ventilator.
Key words: Predictor of mortality, mechanical ventilator

Background: Pneumothorax is an emergency case that needs immediate management. Assessment of lung diseases and causes of pneumothorax is important to manage interdisciplinary therapy and improve the overall quality of management. Risk factors affecting the survival rate of pneumothorax are age and HIV infection, but data is not yet avalaible in Indonesia.
Objective: To determine the characteristics of pneumothorax patients and factors affecting their survival during hospitalization in Cipto Mangunkusumo Hospital, Jakarta.
Methods: Retrospective cohort was conducted on pneumothorax patients who were admitted to Cipto Mangunkusumo Hospital within 2000-2011. Cumulative survival rate in 8 days of hospitalization and the affecting factors underwent bivariate analysis using Kaplan-Meier method and log-rank test, and multivariate analysis using cox proportional hazard regression model.
Results: Among 104 included subjects, their mean age was 39.7 years (SD ± 16.2 years) with a male to female ratio of 3:1. Most common symptom was shortness of breath (99%) and abnormality on physical examination was hypersonor (97.1%). Most plain chest X-ray data showed hyperlucent avascular (91.4%). Most common etiology of secondary pneumothorax were smoking (41.3%), pneumonia (40.3%) and tuberculosis (35.5). Most common type of pneumothorax was secondary spontaneous pneumothorax (47.1%). Most of the patients were successfully managed using water-sealed drainage (94.2%). As many as 66.3% of the subjects survived. Major cause of death was respiratory failure (45.8%). Factors that worsen the survival rate were chest trauma (HR=3.49; 95%CI 1.52-8.04) and pulmonary tuberculosis (HR=3.33; 95%CI 1.39-7.99).
Conclusions: Factors that worsen the survival rate of pneumothorax patients were pulmonary tuberculosis and chest trauma.
Key words : Pneumothorax, survival

Sindrom vena kava superior (SVKS) merupakan kumpulan gejala akibat obstruksi aliran darah yang melewati vena kava superior. Obstruksi terjadi karena desakan massa intra torakal yang umumnya berupa massa mediastinum, massa paru, limfoma, atau penyebab non-maligna. Pada laporan kasus kali ini, obstruksi vena kava superior berlangsung perlahan dan disebabkan struma intra torakal yang terletak di mediastinum anterior superior. Kumpulan gejala klinis pada pasien menunjukan SVKS namun pemeriksaan lanjutan diperlukan untuk menegakkan diagnosis pasti massa penyebab. Ct scan torak, thyroid scan dilakukan untuk membantu mengarahkan pelaksanaan biopsi. Keputusan untuk melakukan biopsi terhadap massa mediastinum perlu mempertimbangkan beberapa hal, yaitu (1) ada tidaknya gejala, (2) lokasi dan luasnya lesi, (3) ada tidaknya beberapa penanda tumor, dan (4) gallium uptake oleh massa. Modalitas terapi definitif akan ditentukan berdasarkan jenis massa penyebab.

Definisi
Flexible bronchoscopy merupakan suatu prosedur invasif untuk memvisualisasikan nasal, faring, laring, korda vokalis, dan percabangan trakea- bronkial untuk keperluan diagnosis serta pengobatan pada kelainan paru. Prosedur ini dapat dilakukan di ruang bronkoskopi, ruang endoskopi, kamar operasi, instalasi gawat darurat, ruang radiologi, dan di unit perawatan intensif
Peralatan
Peralatan yang diperlukan untuk melakukan prosedur adalah bronkoskop, lampu, sikat sitologi, forsep biopsi, needle aspiration catheter, suction, oksigen, fluoroskopi (C-arm), pulse oxymetry, sphygmomanometer dan peralatan resusitasi yang meliputi endotracheal tube serta monitor video.

Tindakan prosedur di bidang pulmonologi intervensi seperti bronkoskopi fleksibel dan rigid serta pleuroskopi, menyebabkan nyeri dan ansietas. Pada pelaksanaan tindakan prosedur tersebut, klinisi umumnya dapat menggunakan anestesi lokal berupa infiltrasi lidocaine pada dinding thoraks dan pleura parietal (untuk pleuroskopi) serta inhalasi lidocaine dan lidocaine topikal (pada bronkoskopi). Selain itu, dapat digunakan sedasi dan analgesia prosedural (PSA), yang dapat mengurangi rasa tidak nyaman, ketakutan, dan timbulnya memori yang tidak menyenangkan akibat tindakan prosedur dan dapat memfasilitasi kelancaran tindakan prosedur tersebut

Background: Metabolic syndrome is a combination of central obesity, elevated blood pressure, impaired glucose metabolism, and dyslipidemia. Its prevalence is increasing worldwide. Several previous studies showed various differences of lung functions in patients with and without metabolic syndrome .
Objective: To determine whether patients with metabolic syndrome had lower FEV1 percent predicted and FVC percent predicted than normal population.
Methods: The study design was cross-sectional study. Patients were grouped into subjects with and without metabolic syndrome who met the inclusion and exclusion criteria.
Results: There were 96 subjects of the study with a mean age of 42.74 ± 9.14. Metabolic syndrome group consisted of 48 subjects and there were 48 healthy subjects in control group. FVC percent predicted values in subjects with and without metabolic syndrome were 99.27 ± 20.35 vs. 116.22 ± 20.67 (p < 0.001), and FEV1 values were 116.05 ± 23.77 vs 130.06 ± 20.78 (p = 0.03). In patients with metabolic syndrome, 16.7% had FEV1 < 80% predicted that indicated decline in lung function (obstruction type), and 22.67% had FVC < 80 % predicted indicating a decline in lung function (restriction type).
Conclusion: Patient with metabolic syndrome had lower FEV1 and FVC values than normal population.
Keywords: Metabolic syndrome, pulmonary functions

Pulmonary Tuberculosis (PTB) is a common manifestation in adults with TB-HIV co-infection. However, as the immunity gets worse, HIV-infected individuals more often develop extrapulmonary and disseminated TB. The Incidence of extrapulmonary TB (EPTB) has increased after the epidemic of HIV infection. It is responsible for 10-50% of all TB case among HIV negative individuals, while in HIV positive group, it occurs in 38-80%.1 Several studies found that up to 50% TB-HIV patients die during TB treatment.2,3 In Thailand, verbal autopsies, laboratorium data, and medical records of TB-HIV patients who die during TB treatment state that TB is the cause of death in 27% of those patients, whereas more than a half of them were disseminated and Multi Drug Resistant TB (Complicated EPTB).2
In many part of the world, many studies had mentioned susceptibility of HIV patients to develop extrapulmonary TB.4-6,8 Additionally, in the recent guideline to improve diagnosis and treatment of extrapulmonary TB, World Health Organization (WHO) states EPTB in HIV-infected person has become a new clinical problem especially in remote area where advance modality supporting diagnosis and treatment are unavalaible. Although pulmonary TB is the most common presentation of TB disease, it can involve any organ in the body. Extrapulmonary Tuberculosis is defined as the isolated occurrence of TB in any part of the body other than lungs such as lymph nodes, abdomen, genitourinary system, musculoskeletal and meninges. Mycobacteria may spread to any organ of the body through lymphatic or haematogenous dissemination and lie dormant for years at a particular site before causing disease. Manifestations may relate to the system involved, or simply as prolonged fever and non specific systemic symptoms. Tuberculosis is a worldwide disease and one of the major health problems of Indonesia. Extrapulmonary tuberculosis is increasing all over the world. However, only limited data is available about the situation of EPTB in developing countries including Indonesia, hence diagnosis may be elusive and is usually delayed.1,3 This study reviews the general spectrum of cases diagnosed with EPTB at a large HIV referral center (POKDISUS) and presents their key demographics, dominant infection sites and the laboratory findings.

Key words: Extrapulmonary Tuberculosis, HIV

Penyakit Paru Obstruktif Kronis (PPOK) merupakan salah satu penyakit yang memilki beban kesehatan tertinggi.World Health Organization (WHO) dalam Global Status of Non-communicable Diseases tahun 2010 mengkategorikan PPOK ke dalam empat besar penyakit tidak menular yang memiliki angka kematian yang tinggi setelah penyakit kardiovaskular, keganasan dan diabetes. GOLD Report 2014 menjelaskan bahwa biaya untuk kesehatan yang diakibatkan PPOK adalah 56% dari total biaya yang harus dibayar untuk penyakit respirasi. Biaya yang paling tinggi adalah diakibatkan kejadian eksaserbasi dari penyakit ini.1 Kematian menjadi beban sosial yang paling buruk yang diakibatkan oleh PPOK, namun diperlukan parameter yang bersifat konsisten untuk mengukur beban sosial. Parameter yang dapat digunakan adalah Disability-Adjusted Life Year (DALY), yaitu hasil dari penjumlahan antara Years of Life Lost (YLL) dan Years Lived with Disability (YLD). Berdasarkan hasil perhitungan tersebut, diperkirakan pada tahun 2030, PPOK akan menempati peringkat ketujuh, dimana sebelumnya pada tahun 1990 penyakit ini menempati urutan keduabelas

Latar belakang: Prosedur trakeostomi dapat menurunkan hambatan udara (apabila dibandingkan dengan selang endotrakea), memiliki potensi untuk menurunkan penggunaan obat sedasi dan analgesia sehingga dapat memfasilitasi proses penyapihan dan menghindari pneumonia terkait ventilator. Batasan waktu atau saat yang optimal untuk melakukan trakeostomi pada pasien tersebut hingga kini masih dalam perdebatan. Berbagai penelitian terdahulu menunjukkan hasil keluaran yang berbeda-beda terutama terhadap insiden mortalitas dan morbiditas. Tujuan: Mengetahui insiden mortalitas pada pasien dengan trakeostomi dini dan trakeostomi lanjut di unit perawatan intensif dan hubungan antara jarak waktu trakeostomi dengan mortalitas perawatan unit intensif. Metode: Penelitian dengan desain kohort retrospektif, dilakukan terhadap 162 pasien kritis dengan ventilasi mekanik yang menerima tindakan trakeostomi selama perawatan intensif di RSUPN Dr. Cipto Mangunkusumo pada kurun waktu Januari 2008-Desember 2012. Data saat untuk melakukan trakeostomi, klinis, laboratorium,
dan radiologis dikumpulkan. Pasien diamati untuk melihat kejadian mortalitas selama perawatan intensif. Analisis hubungan antara saat trakeostomi dengan mortalitas perawatan intensif menggunakan tes X2. Analisis multivariat dengan regresi logistik digunakan untuk menghitung adjusted odds ratio (dan interval kepercayaan 95%) antara kelompok trakeostomi dini dan lanjut untuk terjadinya mortalitas perawatan intensif dengan memasukkan variabel-variabel perancu sebagai kovariat.
Hasil: Terdapat hubungan yang tidak bermakna antara trakeostomi dini dan lanjut dengan mortalitas unit perawatan intensif pada uji X2 (p=0,07) dengan RR 0,67 (IK95% 0,51-1,05). Insiden mortalitas pada trakeostomi dini dan lanjut sebesar 28,4% dan 42%.
Kesimpulan: Kelompok trakeostomi dini cenderung untuk memiliki insiden mortalitas yang lebih rendah dibandingkan dengan trakeostomi lanjut. Namun saat trakeostomi tidak berhubungan dengan mortalitas unit perawatan intensif secara statistik.
Kata kunci: Jarak waktu trakeostomi, unit perawatan intensive, mortalitas

Procalcitonin (PCT) is a protein composed of 116 amino acid with a molecular mass of 13 kDa.1 The definite source of serum PCT is uncertain, but it has been speculated that PCT is produced by liver cells, monocytes
cells, and macrophage cells in response to infection.2 Serum PCT levels increase rapidly during various bacterial infection, especially Gram-negative bacterial infections.3 The outer membrane component of Gram-negative bacteria (i.e. endotoxin or lipopolysaccharides) has been shown to be a strong inducer of PCT
during bacterial infection. These bacteria cause the host to produce pro-inflammatory cytokines,
which leads to increased PCT production.3,4 Elevated cytokines levels also cause the host to
increase production of leucocyte and neutrophils cells. The lipopolysaccharides component plays
a large role in the severity of Gram-negative infections. In clinical settings, PCT together with
leucocyte and neutrophil counts are commonly used as markers of infection.5
Salmonella species, a cause of typhoid fever, are also Gram-negative bacteria that contain endotoxin on their cell surface. Binding of salmonella endotoxin to CD14/Toll-like receptor (TLR)4 on macrophage cells activates
nuclear factor kappa B (NFκB) to produce pro-inflammatory cytokine and increase inflammatory cytokines, resulting in elevated PCT levels.6,8 In clinical practice, leucocyte and neutrophil counts can be used as a marker of bacterial infection.9 In addition, several studies have reported that serum PCT levels are useful
in distinguishing Gram-negative bacteremia from Gram-positive bacteremia.3,10 However,
there have been no studies comparing laboratory markers of bacterial infection in Gram-negative
and Salmonella bacteremias. Therefore, we conduct this study to investigate the differences
in leucocyte and neutrophil cell counts and PCT levels among Salmonella and Gram-negative
bacteremias.