The accuracy of SIRS criteria, qSOFA and SOFA for mortality suspected sepsis patient admitted to the Intensive Care Unit Dr. Hasan Sadikin General Hospital Bandung, January-December 2017


Objective: The high mortality rate found on infectious patients in the intensive care unit (ICU) calls for sepsis identification tools. Sepsis consensus introduced Systemic Inflammatory Response Syndrome (SIRS) criteria, quick Sequential Organ Failure Assessment (qSOFA) score, and Sequential Organ Failure Assessment (SOFA) score. This study aimed at comparing the accuracy and quality to discriminate among the SIRS, qSOFA score, and SOFA score for predicting mortality among patients at risk of sepsis admitted to the ICU.

Design: This study used the analytic observational method with retrospective cohort approach to a sample of 73 qualified medical record data. The data regarding the SIRS, qSOFA, and SOFA criteria were applied after 24 hours of ICU admission.

Setting: ICU of Dr. Hasan Sadikin General Hospital, Bandung from January to December 2017.

Measurements and results: The results of this study showed the SOFA score as being the most accurate and having a good quality to discriminate, with the value of area under the receiver operating characteristic (AUROC) 0.866 (95% CI 0.782-0.95; p=0.00); the qSOFA score had AUROC of 0.707 (95% CI 0.588-0.826; p=0.002) while SIRS criteria were not significant.Conclusions: The conclusion of this study is that in patients with suspected sepsis admitted to an ICU, the SOFA score is the most accurate to predict mortality, whereas qSOFA could be considered and the SIRS criteria is not recommended.

Authors: Tinni T. Maskoen, LS Philip, Indriasari, I. Fuadi

Prediction of optimal right internal jugular vein catheter depth: comparison between Peres’ formula and intracavitary ECG


Background: Incorrect central venous catheter (CVC) placement can lead to serious complications. In order to prevent complications, CVC insertion depth can be predicted using Peres’ formula or intracavitary electrocardiography (ECG). The accurate prediction of optimal CVC depth using Peres’ formula and intracavitary ECG on Malay race is unknown.

Objective: To compare the accuracy of Peres’ formula and intracavitary ECG in predicting the optimal depth of right internal jugular venous catheter on adult Malay race.

Methods: This was a comparative analytic observational study with cross sectional design conducted at Cipto Mangunkusumo National General Hospital Jakarta from May to July 2017. After obtaining approval from the local ethical committee, right internal jugular venous catheter insertion was attempted on 111 patients, but 7 subjects were excluded from the study. Statistical analysis was performed on 104 samples to determine the accuracy of CVC depth prediction based on Peres’ formula and intracavitary ECG using McNemar’s test. The CVC depth prediction formula in adult Malay subject was calculated using linear regression based on its correlation with age, height, and body weight.

Results: The accuracy of intracavitary ECG and Peres’ formula to predict the optimal depth of right internal jugular venous catheter was 75% and 11.5%, respectively. The difference between the accuracy of these two methods was statistically significant (p=0.001). Correlation analysis showed a significant relationship between height and the optimal depth of right internal jugular vein catheter. The CVC depth prediction formula obtained in this study was 4.143 + (0.058 x height in cm).Conclusion: Prediction of right internal jugular venous catheter depth using intracavitary ECG is more accurate than the Peres’ formula.

Authors: Aida Rosita Tantri, Aldy Heriwardito, Hana Nur Ramila

Intubation practices at Wellington Hospital Emergency Department: an eight month retrospective observational study


Objective: To determine the rate of intubations carried out in Wellington Hospital Emergency Department (tertiary hospital), New Zealand, to provide a description of intubating habits of clinicians including operator experience and methods, and to determine the rate of complications.

Design: Eight month, retrospective, observational study.

Setting: Wellington Hospital Emergency Department(WHED).

Location: New Zealand.

Patients and participants: All patients intubated in the Emergency Department were included.

Interventions: None. Audit related activity.

Measurements and results: Over the eight months 57 intubations occurred. The most common indications for intubation were head injury with reduced Glasgow Coma Scale (GCS) and overdose (both 18.9%) followed by stroke, seizure and cardiac arrest (9.4-11.3%). Most intubations (46%) occurred between 8 a.m.-5 p.m. Eighty-two point seven percent of patients were intubated by ED doctors where seniority of team leader and intubating doctor varied according to the time of day. Intubation was consultant led 68.4% of the time before 5 p.m. and 40% of the time overnight. Airway checklist use was reported in 54.5% with formal airway assessment documented in 50%. Successful first pass occurred in 77.2% of cases. Difficult laryngoscopy (grade 3-4) was reported in 16.6% using direct laryngoscopy and 18.8% using videolaryngoscopy. All patients were successfully intubated orally in 3 attempts or less. Etomidate was drug of choice (54.7%). Seventeen point five percent experienced one or more complications. Trends towards less complications related to direct laryngoscopy compared to videolaryngoscopy and use of cricoid pressure associated with a higher complication rate were noted. However there were low numbers and statistical significance was not reached.

Conclusion: The first pass success rate for intubation was lower in comparison to other studies although adverse event rate was also lower. As a high-risk procedure, an incidence of seven intubations per month highlights the need for more diverse training opportunities for skills maintenance.

Authors: Kate Barnett, Ross Freebairn, Saptarshi Mukerji, Christopher Poynter, Louise Poynton, Christopher White

Toward having safe environment in critical care units: a multisite study


Objective: This study was conducted to assess the safety culture in Jordanian intensive care units.

Design: The study was descriptive, cross-sectional design, and multisite.

Setting: The Safety Attitude Questionnaire-Intensive Care Unit (SAQ-ICU) version was utilized. Three hundred completed questionnaires were returned from four critical care units.

Results: The results offered a fundamental element for further research on safety matter in Jordanian ICUs. Many recommendations were highlighted by the Jordanian nurses in order to improve the safety culture in the ICUs including standard nurse-patients ratio, good communication and collaboration between health professionals, enhance continuing education and training. To the knowledge, this is the first study conducted in Jordan using the SAQ to examine nurses’ safety culture attitudes in Jordanian ICUs.

Conclusion: The present findings provide a baseline for future research aiming for improving the quality of care in Jordanian ICUs.

Authors: Loai Abu Sharour, Khaled Suleiman, Suhair Al-Ghabeesh

Barriers to effective in-hospital resuscitation: lessons learned during implementation of a hospital-wide code system


Aims and objectives: To understand the barriers involved in effecting a hospital-wide code system and overcoming them during implementation.

Background: Improving survival after in-hospital cardiac arrest involves standardization of both defibrillation equipment and staff's abilities during codes.

Design: Observational descriptive study.

Methods: Observational study of the situation existing before implementation of an effective in-hospital resuscitation system and description of the implementation process. Descriptive statistics were used.

Results: Prior to intervention, defibrillators were unstandardized, misused and often inaccessible. Basic and advanced life support training was suboptimal and poorly overseen. Codes were attended by curious bystanders and inappropriate staff; there was lack of clarity regarding roles and key interventions. A standard defibrillator model was purchased and gradually deployed throughout the hospital; these were configured to meet the unique requirements of each department. Training was restructured. Standard operating procedures were created for all resuscitations while an oversight mechanism was installed. Code teams were created by taking departmental workloads and clinical skills into consideration. A nurse resuscitation coordinator was appointed per department and a hospital-wide culture was fostered where nurses were responsible for the quality of CPR. Major limiting issues such as distrust of device accuracy and safety, knowledge gaps and problems at the device-user interface were identified and bridged.

Conclusions: Creation of an effective in-hospital code system requires thorough research into the culture and requirements of various hospital departments. Multiple barriers must be overcome to set this process into motion.

Relevance to clinical practice: Implementation of change requires more than a declaration from supervisors; it requires deep understanding of the existing culture of different departments to take effective root. Awareness of these often unacknowledged issues combined with the willingness to confront and overcome them are keys to success.

Authors: Sharon Einav, Nechama Kaufman, Joseph Varon

Medication incompatibility in intravenous lines in a Paediatric Intensive Care Unit (PICU) of Indonesian hospital


Objectives: Currently, little is documented concerning the patterns of multiple concurrent medication use utilising single intravenous line. The in-line compatibility issues in Paediatric Intensive Care Units (PICUs) are not as well documented as in adult patients either. This study closely examined the combination of medications used concurrently in a PICU, recorded how medications were used, and then investigated the in-line potential compatibility.

Methods: This study was a mixed model designed first to identify retrospectively the patterns of multiple medication use at any single time of administration (STA). Secondly, a questionnaire was distributed to practitioners to elucidate their perceptions about incompatibility.

Results: From a single lumen peripheral line in-vitro simulation, it was observed that three infusions typically met in sequential Y-sites and had the potential to interact. The combinations identified were morphine+midazolam, midazolam+fentanyl+morphine, morphine+fentanyl+dobutamine, morphine+midazolam+ketamine, and midazolam+dobutamine+norepinephrine. Compatibility data covering simultaneous administration of three-or-more intravenous drugs was not found in 97.5% (n=120) of the cases. Most practitioners (92.9%) recognized incompatibility. Many (46.4%) said they observed >3-10 in-line incompatibilities in a month. Most nurses (78.5%) reported using the manufacturer as their reference source for compatibility data. Flushing with clear fluid between doses was the most used method to prevent incompatibility (45.5%).

Conclusions: It was a common practice to concurrently administer three or more medications: analgesics, sedatives, inotropes, and others, through the same port with major potential for incompatibility issues. Most of the literature is based on two drug comparisons with minimal information on using combinations of three or more. Most practitioners’ understanding of the implications of the terminology of “incompatibility not known or possible” for their patients appeared lacking.

Authors: Suci Hanifah, Patrick Ball, Ross Kennedy

Association of vitamin D plasma concentration with the severity of illness among children with sepsis treated in Pediatric Intensive Care Unit


Objective: To investigate whether vitamin D plasma concentration correlated with the severity of illness in sepsis children treated in a Pediatric Intensive Care Unit (PICU).

Design: This was a cross sectional study.

Settings: Pediatric Intensive Care Unit of Sanglah Hospital Denpasar, Bali, in May to November 2016.

Patients and participants: Samples were patients aged 28 days to 12 years who had sepsis or severe sepsis or septic shock and have been hospitalized in PICU. The subjects who met the inclusion criteria were divided into two groups based on the vitamin D status: normal and insufficient.

Intervention: The severity of illness of the patients in each group was measured using Pediatric Logistic Organ Dysfunction (PELOD) II and Pediatric Risk of Mortality (PRISM) III score. The demographic data, anthropometric status, and severity of the illness were taken from the medical records. The amount of sun exposure and patient nutritional intake were taken from questionnaires answered by the parents.

Results: A total of 48 patients were examined in this study. Bivariate analysis showed that vitamin D insufficiency was associated with a higher severity of sepsis based on the PRISM III (r=-0.44, p=0.006) and PELOD score (r=-0.5, p<0.001).

Conclusion: Vitamin D plasma concentration was negatively correlated with the illness severity in children with sepsis.

Authors: Dyah Kanya Wati, Putu Mas Vina Paramitha Cempaka, I Nyoman Budi Hartawan, Ida Bagus Suparyatha

Resuscitation after cardiac surgery in Australia: a survey of practice and the implementation of a training course


Objective: To characterise the out-of-hours cover of Cardiac-Surgical Intensive Care Units in Australia, the experience of covering physicians in the training, and management of, cardiac arrest after cardiac surgery, and to describe a novel educational course.

Design: Nighttime phone survey with doctors on public cardiac intensive care units across Australia. Members of nursing, intensive care, and cardiac surgery staff, devised a dedicated half-day course to address the principles of managing a cardiac arrest post-cardiac surgery.

Setting: Tertiary teaching hospital in Sydney, New South Wales, Australia.

Patients and Participants: No patient data used. Qualitative and quantitative feedback from doctors covering intensive care units, and participants, on a pilot course designed to formally train medical and nursing personnel in the management of cardiac arrest after cardiac surgery.

Interventions: Design and implementation of a new training course.

Measurements and Results: We demonstrated wide variation in the availability of training opportunities in Cardiac-surgical Unit-Advanced Life Support, with few units having cardiothoracic surgical doctors on site at night, and the majority of units being covered by a registrar grade, intensive care trainee, out-of-hours. Our pilot course was feasible, well received, and demonstrated improvements in candidates’ confidence in managing cardiac arrests, and their ability to perform, or assist with, emergency re-sternotomy.

Conclusions: The experience of doctors covering cardiac intensive care units varies greatly. There is a lack of dedicated guidelines covering the management of cardiac arrest in the post-cardiac surgical population, with wide variability in whether institutions offer training for this emergency, and how frequently these opportunities are available. There is also a lack of trained medical staff on-site, out-of-hours, able to perform emergency re-sternotomy.

Authors: David John Melia, Richard Pieter Ruberti, Kimberley Smith, Sarah Emily Owen

Colistin resistance in organisms causing ventilator-associated pneumonia - Are we going into pre-antibiotic era?


Introduction: Ventilator-associated pneumonia (VAP) is one of the most common infections in mechanically ventilated patients. VAP is usually caused by multidrug resistant bacteria. The beta-lactam antibiotics, which were once considered the backbone of antibiotic therapy is under strain due to a variety of bacterial antibiotic resistance. Recent evidence suggests that colistin is the only cannon left in the medical armory to treat bacterial infections, mainly those acquired in the hospital that no other drug can treat. But excessive use of colistin has recently led to resistance to these group of drugs. Initially, resistance to colistin was due to mutations but recently detected plasmid-mediated colistin resistance, which is transferrable, heralds the breach of the last group of antibiotics, polymixins. Colistin resistance is on the rise, especially in South East Asia countries. So strict infection control policies are required to control the spread of this infection.

Objective: This study was conducted to see the burden of colistin resistant organisms causing VAP in ICU of Himalayan Institute of Medical Sciences, Dehradun, India.

Design: A prospective observational study.

Setting: Study was conducted in a 40-bed semi-closed ICU of a tertiary care super specialized hospital between August 2016 to April 2017.

Patients and participants: Out of 2304 patients admitted to ICU 420 had a suspicion of VAP. A total of 476 lower respiratory tract samples were collected from 400 patients with clinical evidence of lower respiratory tract infections in form of endotracheal (ET) aspirate, tracheal tube (TT) aspirate, and bronchoalveolar lavage (BAL) specimens.

Intervention: Organism identification and the susceptibility testing were done by using an automated system VITEK 2.

Result: Out of 476 sample received, only 186 samples organisms were isolated, which showed Acinetobacter baumanii was the most common organism. It was found that 19 organisms had resistance to colistin. Klebsiella pneumoniae (25.7%) was the most common organism, which was resistant to colistin, followed by Pseudomonas aeruginosa (16%) and Acinetobacter baumanii (2.4%).

Conclusion: The emergence of colistin resistant strains is a very serious problem as there are only few treatment options. As colistin use is a risk factor for colistin resistance, colistin should not be used alone, combination therapy should be preferred.

Authors: Sonika Agarwal, Barnali Kakati, Nand Kishore, Sushant Khanduri, Mukta Singh

Vitamin D deficiency and outcome of patients with sepsis in pediatric intensive care unit: a prospective observational study


Background: Vitamin D is important in immunomodulation, regulation of inflammation and cytokines, cell proliferation, cell differentiation, apoptosis, angiogenesis, muscle strength, and muscle contraction. Patients with sepsis have high mortality rate and high deficiency in vitamin D. (1) Vitamin D is increasingly recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of sepsis. (2) Vitamin D also influence cardiovascular function. (3) We aimed to find the correlation of vitamin D level with severity of sepsis in patients admitted to pediatric intensive care unit (PICU).

Setting: Participants and laboratory were collected from patients with sepsis who admitted to the PICU at Dr. Sardjito General Hospital, Yogyakarta.

Patients and Participants: Participants pediatric sepsis patients admitted to the PICU from September 2015 to April 2016. Blood samples for 25-hydroxyvitamin D [25(OH)D] concentration were collected at the first 24 hours admission in PICU using ELISA method. Other data recorded include pediatric logistic organ dysfunction (PELOD) score at admission, PICU length of stay and mortality.

Measurement and results: A total of 297 patients were admitted to the PICU during the 8-month study period. Fourty-two patients had diagnosis of sepsis, severe sepsis or septic shock on PICU admission. Of all these studied patients, 25(OH)D deficiency was identified in 23 (54.8%) patients, insufficiency in 9 (21.4%) patients, and normal levels in 10 (23.8%) patients. PICU mortality was higher in patients with 25(OH)D deficiency, ie 7 (30.44%) patients, but it did not show any statistical significance compared to the group of patients with 25(OH)D insufficiency or normal level of 25(OH)D group of patients (p=0.78). The group with normal level of 25(OH)D had the highest PELOD score but on the other hand they have the lowest mortality rate.

Conclusions: There is a high prevalence of vitamin D deficiency in pediatric sepsis patients admitted to PICU, but not correlated with PELOD score on admission. PICU lenght of stay also not associated with mortality in PICU.


Electrocardiography Holter monitoring abnormalities in acute intracerebral hemorrhages


Objective: To avoid the misinterpretation of electrocardiogram (ECG) abnormalities in acute intracerebral hemorrhage (ICH), it is important to recognize ECG abnormalities in such patients. Previous studies have reported ECG disorders in ICH patients based on a single ECG tracing. In this study, we used ECG Holter monitoring to determine ECG abnormalities in acute ICH patients.

Methods: This was a prospective analysis of acute (up to 24 hours following admission) non-traumatic ICH patients who were admitted to our hospital between January 2014 and April 2015. Initially, an ECG and cerebral computed tomography (CT) scan were obtained within the first day of admission. The patients then underwent ECG Holter monitoring for 24 hours. Finally, the ECG abnormalities and their association with the CT scan findings were analyzed.

Results: This study included 108 patients with acute non-traumatic ICH. The most frequent ECG abnormalities shown by Holter monitoring were ectopic beats (85.2%), followed by sinus tachycardia (63.2%). Only the presence of midline shift on the CT scan had a significant correlation with ectopic beats (OR: 1.3, CI: 1.05-1.7).

Conclusion: ECG Holter monitoring in 108 acute ICH patients demonstrated a correlation between the presence of midline shift on the cranial CT scan and ectopic beats in the ECG Holter monitoring.

Authors: Marjan Asadollahi, Mahtab Ramezani, Fatemeh Sharif, Ehsan Karimialavijeh

Initial caloric administration as a risk factor for mortality in critically ill children


Background: The mortality rate of critically ill children with multiple organ dysfunction syndrome (MODS) in Indonesia is approximately 51.85%. Various studies suggested malnutrition as a risk factor for mortality; therefore, nutrition therapy in the form of initial caloric administration became imperative.

Objective: To determine the relationship between initial caloric administration (initial route, initial time and the fulfilment of caloric requirement) and mortality of critically ill children.

Design: Case-control study.

Setting: The Pediatric Intensive Care Unit (PICU) of Dr. Sardjito General Hospital Yogyakarta in 2015.

Patients and participants: Children aged 1 month to 18 years old hospitalized in the PICU for at least 4 days in 2015. Subjects were divided into case group (non-surviving patients) and control group (surviving patients).

Measurements and results: We used McNemar test and stepwise conditional logistic regression for data analysis. From 102 subjects (51 in each group), the proportion of malnourished children in the case group was higher than in the control group (58.8% and 29.4%, respectively). Parenteral route and lack of caloric achievement within the 3rd to 6th day of hospitalization significantly increased the risk of mortality (p<0.05) with ORs of 13 (95%CI 1.95 to 552.47), 3.8 (95%CI 1.37 to 13.02), 4.25 (95%CI 1.39 to 17.26), 4.00 (95%CI 1.08 to 22.09), and 10.0 (95%CI 1.42 to 433.98), respectively. Caloric initiation after the first 48 hours of hospitalization did not significantly affect the mortality rate (p>0.05). Confounding variables that affected mortality include the severity of disease, use of ventilator, hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and malnutrition (p<0.05). Multivariate analysis revealed that parenteral route and malnutrition significantly influenced mortality with ORs of 36.05 (95%CI 3.22 to 404.13) and 9.04 (95%CI 2.09 to 39.19), respectively.

Conclusion: There is a relationship between route of initial caloric administration and mortality of critically ill children, where parenteral nutrition significantly influenced mortality in critically ill children.

Authors: Melia Yunita, Titis Widowati, Nurnaningsih, Desy Rusmawatiningtyas

Difference in serum procalcitonin levels between decompensated liver cirrhosis patients with and without bacterial infection


Background: Decompensated liver cirrhosis may increase procalcitonin (PCT) levels in patients without bacterial infection. Previous studies have not provided conclusive results about the difference in serum PCT levels caused by specific liver decompensation and bacterial infection.

Objective: To examine the role of PCT in assisting the diagnosis of bacterial infection in decompensated liver cirrhosis patients.

Methods: A cross-sectional study on decompensated liver cirrhosis patients who were outpatients and admitted to Cipto Mangunkusumo Hospital, Jakarta, was conducted between December 2015 until May 2016. Procalcitonin levels were examined and bacterial infection was identified using standard criteria for each type of infection suspected. Analysis was performed to determine the difference in PCT levels between patients with and without bacterial infection, and to obtain the cutoff point of PCT for bacterial infection diagnosis using the receiver operating characteristic (ROC) curve.

Results: There were 38 patients with decompensated liver cirrhosis, 16 (42.1%) with bacterial infection, and 22 (57.9%) without bacterial infection. Patients with bacterial infection (3.607±0.643 ng/ml) had significantly higher PCT levels than those without bacterial infection (0.738±1.185 ng/ml). The level of PCT for bacterial infection in decompensated liver cirrhosis had an area under the ROC curve of 0.933 (CI 0.853-1.014). The cutoff point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2.79 ng/ml, with a sensitivity of 87.5% and specificity of 86.4%.

Conclusion: The PCT levels of decompensated liver cirrhosis patients with bacterial infection were higher than those of patients without bacterial infection. The cutoff point of PCT for bacterial infection diagnosis in decompensated liver cirrhosis patients was 2.79 ng/ml.

Authors: Rino Alvani Gani, Oska Mesanti, Marcellus Simadibrata, Suhendro, Irsan Hasan, Andri Sanityoso, C. Rinaldi, A. Lesmana

Comparative analysis of clinical pharmacy interventions in a pediatric intensive care unit


Objective: The objectives of this study were 1) to describe and characterize interventions performed by a clinical pharmacist and 2) provide a comparative analysis of length of stay, mortality, and drug charges in control and intervention groups.

Design: This was a retrospective analysis of clinical pharmacy interventions performed in a Pediatric Intensive Care Unit (PICU) over two years. The clinical pharmacy faculty member was a dual-residency trained specialist in pediatric critical care, and was on-site in the PICU for approximately 0.5 full time equivalents.

Setting and patients: The interventions occurred in an 18-bed medical-surgical PICU in a tertiary care children's hospital. All patients admitted to the PICU during the study period were included.

Interventions: The intervention group was comprised of patients admitted to the PICU during the study period for which the clinical pharmacist suggested changes in medication therapy. All other PICU patients were included in the control group. Interventions suggested were varied, including drug dosing adjustments, antibiotic recommendations, sedation recommendations, and discontinuation of drug therapy.

Measurements and main results: On average, there were 4.4 interventions per patient (0.35 interventions per patient-day). Dosing recommendations, pharmacokinetic recommendations, and discontinuation of medications were the most common types of interventions performed. Antibiotics and sedation/analgesia were the most common drug classes for intervention. There were statistically significant differences in the length of stay and mortality of groups, with both higher in the intervention group. Notably, the intervention group also had higher Pediatric Risk of Mortality (PRISM) scores and drug charges, signifying increased severity of illness compared to the control group. Estimated annual cost savings in the intervention group was $ 86,000.

Conclusions: Antibiotics and sedation/analgesia dosing were the most common areas for pharmacy interventions. Patients with higher PRISM scores had increased interventions. Cost savings were considerable even with a part time pharmacist.

Authors: Joseph M. LaRochelle, Kayrah Jack, Brent A. Kitto, Aryn Karpinski, Amy M. Creel

The effect of mild hypothermia therapy in the level of MMP-9 protein and the Marshall CT score in high risk traumatic brain injury


The effect of mild hypothermia therapy (34°-36°C) and alterations of matrix metalloproteinase-9 (MMP-9) were examined in 20 patients with high risk traumatic brain injury (TBI). The neurologic status was assessed using the Full Outline of UnResponsiveness (FOUR) score and the outcome using the Marshall CT score. The objective of this study was to determine serum MMP-9 level and the Marshall CT score. This research used a prospective randomized controlled study and was conducted in RD Kandou Hospital Manado. Patients with high risk TBI (the FOUR score ≤7) were randomized into two groups, with and without mild hypothermia therapy, and were investigated within 24 and 72 hours. The MMP-9 protein levels were estimated using enzyme-linked immunosorbent assay (ELISA). Different levels of these variables were compared in the two groups. The results showed that the level of MMP-9 protein significantly decreased (p<0.05) in the hypothermia group; however, there was no significant improvement of the Marshall CT score (p>0.05) within 24-72 hours. The study concluded that mild hypothermia therapy had a significant influence on the alteration of biomarkers rather than the alteration of anatomical imaging in high risk TBI patients.

Authors: Eko Prasetyo, Andi Asadul Islam, Mochammad Hatta, Djoko Widodo, Ilhamjaya Pattelongi