Background: Tracheostomy is an alternative that is widely used as airway access after the use of a ventilator in the care of critically ill patients. Several factors are known to influence the outcome in patients undergoing tracheostomy. This study aimed to compare the outcomes of critically ill patients installed with mechanical ventilation performed early and late tracheostomy in Dr. M Djamil General Hospital, Padang, Indonesia. Methods: This study was an analytical observational study with a cross-sectional approach. A total of 97 research subjects participated in this study. Data analysis was carried out with the help of SPSS software in a univariate and bivariate manner between tracheostomy time (early and late) with patient outcomes in the form of death and length of stay. Results: There was a statistical difference in the mortality rate in critically ill patients with mechanical ventilation performed early and late tracheostomy, p = 0.014. There is a statistical difference in the length of stay in the intensive care unit in critically ill patients with mechanical ventilation performed early and late tracheostomy with p = 0.000. Conclusion: There are differences in outcomes in the form of mortality and length of stay in critically ill patients who have tracheostomy installed at Dr. M. Djamil General Hospital Padang, Indonesia.

Objective : To report the diagnosis and management of congenital total AV block on VSD and PDA in pregnancy.Method : A case reportCase : A 37-year-old multiparous woman G4P3A0H2 24- 25 weeks of preterm pregnancy with fetal bradycardia, VSD, PDA with ultrasonography and CTG results was FHR 70 bpm. At 37- 38 weeks of pregnancy, termination of pregnancy was performed by cesarean delivery with preparation for complication of fetal AV block. A male baby was born with weight 2600 gram and APGAR score of 8/9. Immediate echocardiography result was situs solitus, VSD PM LR shunt, PDA LR shunt, good left ventricular function, left aortic arch and EF 74%. ECG result was sinus bradycardia, total AV block with junctional escape rhythm. Sternotomy and PPM implantation was performed by cardiothoracic surgeon three hours after the baby was born. Post PPM implantation, ECG results was HR 165 bpm and chest X- rays interpretation was cardiomegaly with plethora. Mother and baby came home in good condition on the 6th day of treatment. On the next baby’s control at 4.5 months obtained a weight of 5.4 kg with the echocardiography results was solitus, VSD PM LàR shunt, VSD muscular multiple 3 pieces LàR shunt, PDA LàR shunt, good right and left ventricular function, and left arch. The child got captopril 2x1.5 mg and planned for a 6-month repeat echocardiography.Conclusion : Congenital of total AV block on VSD and PDA is confirmed by prenatal diagnosis and preparation for comprehensive multidisciplinary management.Keywords: congenital total AV block, fetal bradycardia, fetal echocardiography, PPM, ultrasound