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"Latar Belakang: Coronavirus disease 2019 (COVID-19) memiliki berbagai spektrum gejala klinis salah satunya sesak napas. Sesak napas disertai hipoksia merupakan prediktor penurunan kapasitas fungsional. Uji jalan 6 menit dapat mengidentifikasi sesak napas dan hipoksia pasca-uji latih pada pasien COVID-19 saat perawatan dan pascarawat. Penelitian ini bertujuan untuk mengetahui derajat sesak pada pasien COVID-19 yang dirawat dan pascarawat Metode: Penelitian ini merupakan penelitian kohort prospektif yang dilakukan pada Bangsal COVID-19 dan poli paru RSUP Persahabatan dari Agustus 2021 – Juni 2022. Subjek penelitian adalah pasien COVID-19 derajat ringan atau sedang yang dirawat di Bangsal COVID-19 yang memenuhi kriteria penelitian. Subjek penelitian akan dilakukan uji jalan 6 menit, penilaian skala Borg, saturasi oksigen, skor RALE dan arus puncak ekspirasi saat perawatan dan akan di evaluasi pada 1 bulan dan 3 bulan pascarawat. Hasil: Pada penelitian ini didapatkan 40 subjek penelitian. Nilai rerata uji jalan 6 menit pasien COVID-19 yang dirawat 279,9 m (SB ± 75,4), 1 bulan pascarawat 332 m ((SB ± 63,7) dan 3 bulan pascarawat 394,52 m (SB ± 58). Median saturasi oksigen pasien COVID-19 yang dirawat 97%, 1 bulan pascarawat 97,5% dan 3 bulan pascarawat 98%. Nilai median skala Borg pasien COVID-19 yang dirawat 2, 1 bulan pascarawat 1, 3 bulan pascarawat 1. Arus puncak ekspirasi pasien COVID-19 250 L/menit, 1 bulan pascarawat 310 L/menit dan 3 bulam pascarawat 370 L/menit. Median skor RALE pasien COVID-19 yang dirawat 3, 1 bulan pascarawat 2,5 dan 3 bulan pascarawat 1,5. Terdapat korelasi bermakna skala Borg dengan uji jalan 6 menit, saturasi oksigen dengan uji jalan 6 menit dan uji jalan 6 menit dengan skor RALE, terdapat korelasi bermakna arus puncak ekspirasi dengan skala Borg pada pasien COVID-19 yang dirawat dan 1 bulan pascarawat, terdapat korelasi bermakna saturasi oksigen dengan skala Borg pada pasien COVID-19 yang dirawat dan 1 bulan pascarawat Kesimpulan: Terdapat perbaikan derajat sesak yang ditunjukkan dari hasil uji jalan 6 menit, skala Borg, saturasi oksigen, skor RALE dan arus puncak ekspirasi pada pasien COVID-19 ringan dan sedang yang dirawat dibandingkan 1 bulan pascarawat dan 3 bulan pascarawat.

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Background: Coronavirus disease 2019 (COVID-19) has various clinical symptoms, one of which is shortness of breath. Exertional dyspnea is a predictor of decreased functional capacity. The 6-minute walk test can identify exertional dyspnea and hypoxia in COVID-19 patients during hospitalization and post-hospitalization. This study aims to determine the degree of shortness of breath in hospitalized and post-hospitalized COVID-19 patients. Methods: A prospective cohort study was conducted in the COVID-19 isolation ward and pulmonology clinic National Respiratory Center Persahabatan Hospital from August 2021 – June 2022. The study subjects were mild or moderate COVID-19 patients admitted to the COVID-19 isolation ward who met the research criteria. Patients underwent a 6-minute walk test, assessment of Borg scale, oxygen saturation, RALE score, and peak expiratory flow rate and will be evaluated at a month and three months post-hospitalization. Results: There were 40 subjects participating in this study. The mean of the 6-minute walk test of COVID-19 patients was 279.9 m (SD ± 75.4), one-month post-hospitalized was 332 m (SD ± 63.7) and three months post-hospitalized was 394.52 m (SD±58) Median oxygen saturation of COVID-19 patients was 97%, one-month post-hospitalized was 97.5% and three months post-hospitalized was 98%. Median Borg scale of COVID-19 patients was 2, 1-month post-hospitalized was 1, 3 months post-hospitalized was 1. The median peak expiratory flow rate of COVID-19 patients was 250 L/min, one-month post-hospitalized was 310 L/min and three months post-hospitalized was 370 L/min. Median RALE scores for COVID-19 patients was 3, 1-month post-hospitalized was 2,5 and 3 months post-hospitalized was 1,5. There was a significant correlation between Borg scale and 6-minute walk test, oxygen saturation with the 6-minute walk test and the 6-minute walk test with RALE score. There was a significant correlation between peak expiratory flow and the Borg scale in hospitalized and one-month post-hospitalized COVID-19 patients. There was a significant correlation between oxygen saturation with the Borg scale in COVID-19 patients and one-month post-hospitalized COVID-19 patients. Conclusion: There was an improvement in the degree of dyspnea in mild and moderate COVID-19 patients as indicated by 6-minute walk test distance, Borg scale, oxygen saturation, RALE score and peak expiratory flow rate compared to a-month and three-months post-hospitalized."

"Latar Belakang: Pandemi COVID-19 telah menjadi tantangan besar bagi dunia kesehatan. Tenaga kesehatan merupakan populasi yang sangat rentan tertular dikarenakan tingginya intensitas dan frekuensi pajanan SARS-CoV-2. Risiko penularan meningkat apabila tenaga medis melakukan tindakan yang memicu aerosilisasi, salah satunya adalah intubasi endotrakeal karena tingginya viral load pada saluran napas. Sebanyak 3,2% pasien COVID-19 memerlukan tindakan intubasi endotrakeal dan ventilasi mekanis. Intubasi endotrakeal yang efektif pada pasien COVID-19 penting dilakukan untuk menurunkan mortalitas dan risiko penularan. Penelitian ini bertujuan intuk mengetahui faktor-faktor yang memengaruhi efektivitas intubasi endotrakeal pada pasien terkonfirmasi COVID- 19 di RSUP Persahabatan.Metode: Penelitian ini merupakan penelitian observasional yang menggunakan desain potong lintang yang dilakukan di IGD, ICU Rasmin Rasjid dan ICU PINERE RSUP Persahabatan pada bulan Juni 2021 – Juni 2022. Subjek peneltian ini adalah pasien terkonfirmasi COVID-19 yang dilakukan tindakan intubasi endotrakeal yang memenuhi kriteria inklusi dan eksklusi. Tindakan intubasi endotrakeal dinilai dari observasi rekaman CCTV. Selanjutnya karakteristik subjek, karakteristik intubasi endotrakeal dan faktor-faktor yang memengaruhi intubasi endotrakeal dievaluasi.Hasil: Pada penelitian ini didapatkan 59 subjek penelitian. Proporsi intubasi endotrakeal efektif pada pasien COVID-19 sebesar 20,34%. Median lama waktu tindakan intubasi endotrakeal adalah 38 (19-189) detik. Sebanyak 32 (54,24%) tindakan intubasi endotrakeal dilakukan oleh spesialis anestesi dan 27 (45,76%) oleh PPDS Pulmonologi dan Kedokteran Respirasi. Hasil analisis bivariat didapatkan hasil bermakna secara statistik pada variabel penyakit kardiovaskular+DM (OR 0,24 (IK 95% 0,06-0,91), p=0,028) dan variabel operator (OR 0,07 (IK 95% 0,01-0,62), p=0,004). Hasil analisis multivariat menunjukkan hasil bermakna secara statistik hanya pada variabel operator (adjusted OR 0,06 (IK 95% 0,01-0,60), p=0,016).Kesimpulan: Terdapat hubungan penyakit kardiovaskular+DM dan operator terhadap intubasi endotrakeal efektif pada pasien COVID-19 di RSUP Persahabatan.

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Background: The COVID-19 pandemic has become a major challenge for the healthcare system. Healthcare workers are vulnerable population of COVID-19 transmission due to high intensity and frequency of exposure to SARS-CoV-2. The risk of transmission increases in aerosolization procedure such as endotracheal intubation because of the high viral load in the airways. Approximately 3.2% of COVID-19 patients require endotracheal intubation and mechanical ventilation. Effective endotracheal intubation in COVID-19 patients is important parameter to reduce mortality and the risk of transmission to healthcare workers. This study aims to determine the factors that influence the effectiveness of endotracheal intubation in patients with COVID-19 in National Respiratory Center, Persahabatan Hospital.

Methods: This study is an observational study using a cross-sectional design which was carried out in the emergency department, ICU Rasmin Rasjid and ICU PINERE of National Respiratory Center, Persahabatan Hospital in June 2021 – June 2022. The subjects of this study were COVID-19 patients who underwent endotracheal intubation who met the criteria inclusion and exclusion. The endotracheal intubation procedure was assessed from the observation of CCTV recordings. The characteristics of the subject, the characteristics of endotracheal intubation and the factors that influence endotracheal intubation were evaluated.

Results: In this study, there were 59 subjects. The proportion of effective endotracheal intubation in COVID-19 patients was 20.34%. The median length of time for endotracheal intubation was 38 (19-189) seconds. Among the subjects, 32 (54.24%) endotracheal intubation were performed by anesthesiologists and 27 (45.76%) were performed by Pulmonology and Respiratory Medicine residents. The results of the bivariate analysis showed statistically significant results on the cardiovascular disease + DM comorbid (OR 0.24 (95% CI 0.06-0.91), p=0.028) and operator (OR 0.07 (95% CI 0.01-0.62), p=0.04). The results of the multivariate analysis showed statistically significant results only for operator (adjusted OR 0.06 (95% CI 0.01-0.60), p=0.016).

Conclusion: There is relationship of cardiovascular disease + DM comorbid and operator with effective endotracheal intubation in COVID-19 patients at National Respiratory Center, Persahabatan Hospital."

"Latar Belakang. Obesitas merupakan faktor risiko luaran buruk pada pasien COVID-19. Sampai saat ini studi penilaian hubungan parameter obesitas berupa nilai lemak viseral, lingkar pinggang (LP), indeks massa tubuh (IMT), dan persentase lemak tubuh secara bersamaan dengan luaran COVID-19 menggunakan metode sederhana berupa bioimpedance analyzer (BIA) masih terbatas. Keempat variabel tersebut akan dinilai kemampuannya untuk memprediksi luaran buruk selama perawatan pasien COVID-19.Metode. Penelitian ini merupakan kohort prospektif dari 261 pasien COVID-19 ringan-sedang di RSUPN Cipto Mangunkusumo rawat inap sejak Desember 2020 hingga Maret 2021. Pasien dilakukan pemeriksaan BIA, LP, dan IMT saat admisi. Dilakukan analisis multivariat regresi logistik untuk menilai kemampuan nilai lemak viseral, persentase massa tubuh, IMT dan LP untuk memprediksi luaran buruk komposit yang mencakup ARDS dan mortalitas.Hasil. Didapatkan median nilai lemak viseral 10 (setara 100 cm2 ), lingkar pinggang 93 cm, IMT 26,1 kg/m2 , dan persentase lemak tubuh 31,5%. Berdasarkan multivariat regresi logistik, lingkar pinggang secara statistik bermakna sebagai faktor yang berpengaruh terhadap luaran buruk pada pasien COVID-19 [RR 1,04 (IK 95% 1,01-1,08)] bersama dengan derajat COVID-19 [RR 4,3 (IK 95% 1,9- 9,9)], skor NEWS [RR 5,8 (IK 95% 1,1-31)] saat admisi, dan komorbiditas [RR 2,7 (IK 95% 1,1-6,3)].Kesimpulan. Luaran buruk COVID-19 selama perawatan pasien COVID-19 terkonfirmasi dapat dipengaruhi oleh lingkar pinggang.

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Background. Obesity is a risk factor for adverse outcomes in COVID-19 patients. Until now, studies on assessing the relationship between obesity parameters in the form of visceral fat, waist circumference (WC), body mass index (BMI), and body fat percentage simultaneously with COVID-19 outcomes using a simple method such as bioimpedance analyzer (BIA) are still limited. The four variables will be assessed for their ability to predict adverse outcomes during the treatment of COVID-19 patients.

Method. This study is a prospective cohort of 261 mild-moderate COVID-19 subjects at Cipto Mangunkusumo General Hospital who were hospitalized from December 2020 to March 2021. Patients underwent BIA, WC, and BMI examinations upon admission. Multivariate logistic regression analysis was performed to assess the ability of visceral fat, body mass percentage, BMI, and WC to predict poor composite outcomes, including ARDS and mortality.

Results. The median value of visceral fat was 10 (equivalent to 100 cm2 ), WC was 93 cm, BMI was 26.1 kg/m2 , and body fat percentage was 31.5%. Based on multivariate logistic regression, WC was statistically significant as a factor influencing poor outcomes in COVID-19 patients [RR 1.04 (95% CI 1.01-1.08)] along with COVID-19 degree of severity [RR 4.3 (95% CI 1.9-9.9)], NEWS score [RR 5.8 (95% CI 1.1-31)] at admission, and comorbidities [RR 2.7 (95% CI 1.1) - 6.3)].

Conclusion. During the hospitalization of confirmed COVID-19 patients, poor outcomes can be affected by waist circumference."

"Latar Belakang : Lima belas persen (15%) pasien yang terinfeksi COVID- 19 jatuh ke dalam kondisi penyakit yang berat dan memerlukan suplementasi oksigen (O2). Lima persen (5%) lainnya mengalami perburukan lebih lanjut dan jatuh ke dalam penyakit kritis dengan komplikasi. Pemberian terapi O2 dilakukan segera kepada pasien dengan atau tanpa tanda-tanda kegawatdaruratan dengan saturasi oksigen (SpO2) < 90%. Penelitian ini bertujuan untuk mengetahui hubungan antara Skor Acute Physiology and Chronic Health Evaluation (APACHE) II dengan kejadian desaturasi pada pasien Pneumonia COVID-19.Metode : Penelitian ini merupakan penelitian analitik observasionalkohort prospektif yang dilakukan di Instalasi Gawat Darurat (IGD) dan ruang rawat inap RSUP Persahabatan periode 31 Juli 2021 – 30 September 2021. Subjek penelitian didapatkan dari pasien yang datang ke IGD RSUP Persahabatan sejak 30 Juli 2021 – 30 September 2021 dan terdiagnosis COVID-19 dari hasil pemeriksaan PCR usap tenggorok positif. Dilakukan pengumpulan data klinis, tanda vital, pemeriksaan penunjang dan Skor APACHE II sejak subjek tiba di IGD hingga masuk ruang rawat dalam 24 jam pertama. Hasil : Pada penelitian ini didapatkan 100 subjek penelitian. Hasil penelitian ini menyatakan bahwa tidak terdapat hubungan yang bermakna antara Skor APACHE II dengan kejadian desaturasi pada pasien Pneumonia COVID-19 (p 0,257). Selain itu, tidak ditemukan perbedaan bermakna skor APACHE II pada kelompok pasien dengan derajat keparahan COVID-19 yang berbeda pada PaO2 sesuai hasil pemeriksaan AGD (p 0,073) namun didapatkan hubungan yang bermakna pada penggunaan PaO2 seusai kurva disosiasi O2 (p <0,001).Kesimpulan : Tidak terdapat hubungan yang bermakna antara SkorAPACHE II dengan kejadian desaturasi pada pasien Pneumonia COVID-19.

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Background : Fiftheen percents (15%) patients infected with COVID-19

falls to severe disease and require oxygen (O2) therapy and the other 5% suffered

progressive worsening to critical disease with complications. Oxygen therapy

conducted in patients with or without emergency condition with low O2 saturation

(SpO2 < 90%). This study aim to determine the correlation between Acute

Physiology and Chronic Health Evaluation (APACHE) II score with desaturation

in Pnuemonia COVID-19 patients.

Methods : A prospective cohort observational analytic study

conducted at National Respiratory Ceter Persahabatan Hospital Emergency Unit

from July 2021-September 2021. The study subjects were patients admitted to

Emergency Unit and diagnosed with COVID-19 from positive result of

nasopharing PCR swab. Clinical data, vital signs, supportive examination and

APACHE II score are collected since Emergency Unit admission to inward unit in

first 24 hours.

Results : There were 100 subjects participating in this study. The

result stated there were no significant correlation between APACHE II Score with

desaturation in Pneumonia COVID-19 patients (p-value 0,257). There was also no

significant correlation between APACHE II score with disease severity of COVID-

19 based on O2 partial pressure collected from blood gas analysis examination (pvalue

0,073) but there was a significant correlation between APACHE II score with

disease severity of COVID-19 based on O2 partial pressure referred to O2

dissociation curve (p-value <0,001).

Conclusion : There was no significant correlation between APACHE II

Score with desaturation in Pneumonia COVID-19 patients"

"Penelitian mengenai efektivitas favipiravir pada COVID-19 di beberapa negara memberikan hasil yang beragam. Studi populasi Indonesia masih terbatas pada derajat sedang dan berat. Evaluasi efektivitas dan keamanan favipiravir pada tingkat keparahan ringan dan sedang diperlukan dalam melengkapi pedoman terapi dengan bukti yang sesuai. Penelitian dilakukan secara kohor retrospektif menggunakan rekam medis pasien COVID-19 derajat ringan dan sedang yang dirawat di RS Grha Permata Ibu Depok pada Juli 2020 hingga 2021. Efektivitas dinilai berdasarkan perbaikan klinis saat keluar rumah sakit, hasil PCR akhir, status oksigenasi, dan durasi rawat. 192 rekam medis pasien rawat inap COVID-19 dibagi dalam kelompok favipiravir (n=96) dan non-favipiravir (n=96). Favipiravir memberikan perbaikan klinis yang lebih baik dengan effect size yang kecil (p=0,038; RR=1,19; 95% CI=1,02-1,39). Namun setelah dikontrol variabel usia, jumlah komorbid, dan oksigenasi awal, pemberian favipiravir meningkat menjadi 2,55 kali lebih efektif daripada non-favipiravir. Favipiravir juga memberikan pengaruh signifikan pada hasil PCR akhir serta durasi rawat inap (p=0,009 ; 0,002) namun tidak memberikan perbedaan dalam status oksigenasi (p=0,097). Tidak terdapat perbedaan yang signifikan pada proporsi kejadian yang tidak diinginkan (KTD) selama pemberian favipiravir (30%) dan non-favipiravir (23%) (p=0,33). Pemberian favipiravir secara signifikan terkait dengan peningkatan perbaikan klinis pasien COVID-19. KTD yang muncul selama terapi relatif aman.

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Research on the effectiveness of favipiravir against COVID-19 has yielded mixed results in several countries. Study in Indonesian population was still limited in moderate to severe COVID-19. Assess the efficacy and safety of favipiravir at mild to moderate severity is necessary to complement therapy guidelines with appropriate evidence. The study was conducted in a retrospective cohort using medical records of COVID-19 hospitalized patients at Grha Permata Ibu Hospital Depok from July 2020 to 2021. Efficacy was assessed using clinical improvement at discharge, final PCR results, oxygenation status, and lenght of stay. Medical records of 192 COVID-19 hospitalized patients were divided into favipiravir (n=96) and non-favipiravir (n=96) groups. Favipiravir provided better clinical improvement with small effect size (p=0.038; RR=1.19; 95% CI=1.02-1.39). However, after controlling age, number of comorbidities, and initial oxygenation variables, favipiravir 2.55 times more potent than non-favipiravir. Favipiravir also had a significant effect on final PCR results and length of stay (p=0.009;0.002), but has no difference in oxygenation status (p=0.097). There was no difference in the adverse drug reactions during treatment with antiviruses (p=0.33). Favipiravir administration was significantly associated with enhanced clinical improvement in COVID-19 patients. Side effects that occur during treatment are relatively safe."

"Latar Belakang: The Coronavirus disease 2019 (COVID-19) merupakan infeksi oleh severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) yang menjadi perhatian internasional pada Januari 2020. Manifestasi kasus ringan terjadi sekitar 81%, kasus berat sebanyak 14%. Mortalitas akibat pneumonia COVID-19 meningkat secara global akibat transmisi cepat dan gejala awal yang atipikal. Usia ≥ 60 tahun, jenis kelamin laki-laki dan komorbiditas merupakan faktor risiko untuk menjadi berat dan kematian sehingga dibutuhkan kontrol ketat pada pasien berisiko.Metode Penelitian: Penelitian ini merupakan penelitian retrospektif dengan studi potong lintang. Sampel penelitian merupakan pasien yang datang ke IGD dan terkonfirmasi pneumonia COVID-19 yang masuk dalam kriteria inklusi. Sampel pada penelitian ini adalah sebanyak 299 pasien.Hasil Penelitian: Pada penelitian ini didapatkan subjek penelitian adalah 299 dari 336 pasien yang masuk dalam kriteria inklusi. Jenis kelamin laki-laki sebanyak 162 orang (54,18%), nilai IMT obesitas I (29,77%) dan diikuti IMT normal (28,76%), paling banyak tidak memiliki komorbid dengan derajat pneumonia berat (60,2%) dan luaran pasien sebanyak 69,2% adalah hidup. Komorbid terbanyak yaitu hipertensi (30,77%), Diabetes mellitus (24%) dan kardiovaskular (14%). Usia median hidup pasien pneumonia COVID-19 di RS Persahabatan adalah 52 th (20-84) dan median usia meninggal adalah 59 th (28-92). Terdapat hubungan bermakna antara derajat klinis, HT, IMT dan DM terhadap luaran pasien pneumonia COVID-19 di RS Persahabatan.Kesimpulan: Usia median hidup pasien pneumonia COVID-19 di RS Persahabatan adalah 52 th (20-84) dan median usia meninggal adalah 59 th (28-92). Terdapat hubungan bermakna antara derajat klinis, HT, IMT dan DM terhadap luaran pasien pneumonia COVID-19 di RS Persahabatan.

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Background: The Coronavirus disease 2019 (COVID-19) is an infection by severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) which became international attention in January 2020. The manifestation of mild cases occurred about 81%, severe cases as much as 14%. Mortality of COVID-19 pneumonia increasing globally due to rapid transmission and atypical symptoms. Age of 60 years, male gender and comorbidities are risk factors for severe and death so that strict control is needed.

Methods: This study is retrospective cross-sectional study, which samples were patients who came to emergency room and confirmed of COVID-19. The samples are 299 patients who included of inclusion criteria.

Results: The sample of this study were 299 patients out of 336 patients who were include in inclusion criteria. Male (54.18%) are the most common, Obesity class I was the most common (29.77%) followed by normal BMI (28,76%) and didn’t have comorbid with severe (60.2%) and outcome are survived (69.2%). Hypertension (30,77%) is the most comorbid, followed by diabetes melitus (24%) and cardiovascular (14%). The median age of survivor is 52 (20-84) years old and median age of non survivor is 59 (28-92) years. There was relationship between severe pneumonia to respiratory rate and peripheral oxygen saturation. Gender, number of comorbidities and BMI were not related to the outcome. There is a relationship between the severity of pneumonia, obesity, diabetes and hypertension to the outcome.

Conclusion: The median age of survivor is 52 (20-84) years old and median age of non survivor is 59 (28-92) years. There was relationship between severe pneumonia to respiratory rate and peripheral oxygen saturation. Gender, number of comorbidities and BMI were not related to the outcome. There is a relationship between the severity of pneumonia, obesity, diabetes and hypertension to the outcome."

"Latar belakang: Coronavirus Disease 2019 (COVID-19) adalah penyakit baru. Infeksi saluran napas akibat virus yang disertai infeksi bakteri akan meningkatkan derajat keparahan dan angka mortalitas. Insidens ventilator associated pneumonia (VAP) pada kelompok COVID-19 yaitu 21-64%. Kasus VAP dapat menjadi penyebab tingginya mortalitas pada pasien COVID-19 terintubasi.Metode penelitian : Penelitian ini adalah penelitian retrospektif di RS Persahabatan. Seluruh sampel yang digunakan adalah kelompok pasien COVID- 19 terintubasi >48 jam dalam periode tahun 2020-2022 yang memenuhi kriteria inklusi dan eksklusi.Hasil penelitian : Penelitian ini meliputi 196 data penelitian yang memenuhi kriteria inklusi. Proporsi laki-laki lebih banyak dibandingkan perempuan dan hanya 29% adalah populasi usia lanjut. Proporsi VAP pada COVID-19 terintubasi pada tahun 2020-2022 mencapai 60% dengan VAP rates 92,56. Terdapat dua faktor bermakna terhadap VAP pada pasien COVID-19 terintubasi yaitu penggunaan azitromisin (OR 2,92; IK95% 1,29-6,65; nilai-p 0,01) dan komorbid penyakit jantung. (OR 0.38; IK95% 0,17-0,87; nilai-p 0,023). Proporsi terbesar biakan mikroorganisme aspirat endotrakeal adalah Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), Escherichia coli (9%).Kesimpulan : Proporsi VAP pada COVID-19 terintubasi adalah 60%. Terdapat hubungan bermakna pada penggunaan azitromisin dan komorbid penyakit jantung sedangkan usia lanjut dan penggunaan steroid tidak memiliki hubungan bermakna terhadap VAP pada pasien COVID-19 terintubasi.

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Background : Coronavirus Disease 2019 (COVID-19) is a novel disease. Viral respiratory infection following bacterial infection could increase the severity and mortality of the disease. The incidence of Ventilator (VAP) in COVID-19 group is 21-64%. VAP might be the leading cause of high mortality in intubated COVID-19 patient.

Methods : This research is a retrospective study at Persahabatan hospital. The collected samples is a group of COVID-19 patient intubated for >48 hours in the period of 2020 to 2022 that meet the inclusion and exclusion criteria.

Results : This study consist of 196 data fulfilling the inclusion criteria. Male proportion much greater than female and only 29% is an elderly population. The proportion of VAP in the period of 2020-2022 is 60% with the VAP rates 92,56. There are two factors significantly affected VAP in intubated COVID-19 patient which are the usage of azitromisin (OR 2,92; CI95% 1,29-6,65; p-value 0,01) and cardiovascular disease comorbidity(OR 0.38; CI95% 0,17-0,87; p-value 0,023). The most abundance proportion of endotracheal aspirate microorganism culture are Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), and Eschrichia coli (9%).

Conclusion : The proportion of VAP in intubated COVID-19 is 60%. There are significant association of azitromicin usage and cardiovascular comorbidity while elderly and the usage of steroid are not significantly associated to VAP in intubated COVID-19 patient."

"Latar belakang : Penyakit paru obstruktif kronik (PPOK) saat ini menjadi penyebab kematian nomor tiga didunia. Penyebab kematian paling sering pada pasien PPOK berkaitan dengan kelainan sistem kardiovaskular. Hipertensi merupakan komorbid yang paling sering ditemukan pada pasien PPOK. Pada pasien PPOK terjadi inflamasi sistemik yang dapat menyebabkan peningkatan kekakuan pembuluh darah dan terjadi hipertensi. Pasien PPOK dengan komorbid penyakit kardiovaskular/hipertensi memiliki angka morbiditas, mortalitas, kualitas hidup yang buruk, intoleransi latihan dan risiko rawat inap yang lebih tinggi. Metode : Penelitian ini merupakan penelitian potong lintang yang dilakukan di RSUP Persahabatan periode Maret 2023. Subjek penelitian didapatkan dari pasien PPOK stabil yang datang ke poliklinik asma dan PPOK RSUP Persahabatan. Setelah memenuhi kriteria, dilakukan pengumpulan data klinis, pemeriksaan tanda vital, pemeriksaan spirometri dan DLCO. Hasil : Pada penelitian ini didapatkan 84 subjek penelitian. Hasil penelitian ini mendapatkan proporsi hipertensi pada pasien PPOK stabil sebesar 60,7%. Terdapat hubungan yang bermakna antara nilai faal paru pasien PPOK (derajat GOLD), derajat beratnya PPOK klinis (grup A, B, C dan D), merokok (indeks brinkman) dan usia pasien PPOK dengan hipertensi. Sedangkan lama menderita PPOK dan nilai DLCO tidak didapatkan hubungan yang bermakna. Kesimpulan : Proporsi hipertensi pada pasien PPOK stabil di RSUP Persahabatan sebesar 60,7%. Terdapat hubungan yang bermakna antara nilai faal paru pasien PPOK (derajat GOLD), derajat beratnya PPOK klinis (grup A, B, C dan D), merokok (indeks brinkman) dan usia pasien PPOK dengan hipertensi.

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Background : Chronic obstructive pulmonary disease (COPD) currently is the third leading cause of death in the world. The most frequent cause of death in COPD patients is cardiovascular disease. Hypertension is a comorbid that is often found in COPD patients. In COPD patients, systemic inflammation occurs which can lead to increased vascular stiffness and hypertension. COPD patients with comorbid cardiovascular disease/hypertension have higher rates of morbidity, mortality, poor quality of life, exercise intolerance and risk of hospitalization. Methods : This research is a cross-sectional study conducted at National Respiratory Center Persahabatan Hospital in March 2023. The study subject were stable COPD patient and admitted to asthma and COPD clinic of Persahabatan Hospital. Clinical data, vital signs, spirometry and DLCO tests were collected. Results : There were 84 subjects participating in this study. The results of this study found that the proportion of hypertension in stable COPD patients in RSUP Persahabatan was 60.7%. There was a significant relationship between the lung function of COPD patients (GOLD degree), severity of clinical COPD (groups A, B, C and D), smoking (brinkman index), and age with hypertension. While there was no relationship between how long COPD diagnose, and DLCO. Conclusion : This study found that the proportion of hypertension in stable COPD patients is 60.7%. There was a significant relationship between the lung function of COPD patients (GOLD degree), severity of clinical COPD (groups A, B, C and D), smoking (brinkman index), and age with hypertension."

"Latar Belakang: Gagal napas merupakan salah satu komplikasi terbanyak pada COVID-19 dengan mortalitas dan morbiditas yang tinggi. Pasien yang datang ke IGD dengan tanda gawat napas apabila tidak diberikan tatalaksana yang tepat dapat jatuh pada kondisi gagal napas. Tujuan penelitian ini yaitu untuk mengetahui faktor risiko gagal napas pasien probable dan konfirmasi COVID-19 dengan gawat napas di IGD. Metode: Penelitian ini merupakan penelitian kohort prospektif terhadap pasien gawat napas yang datang ke IGD RSUP Persahabatan. Pengambilan sampel dilakukan secara consecutive sampling mulai 1 September 2020 - 31 Oktober 2020. Dilakukan pemeriksaan kesadaran, status respirasi (frekuensi napas, saturasi oksigen), status kardiovaskular (mean arterial pressure, frekuensi nadi) dan penggunaan otot bantu napas kemudian dilakukan observasi apakah terjadi gagal napas dalam 14 hari perawatan. Nilai potong faktor klinis gawat napas ditentukan dengan kurva area under curve (AUC) kemudian dilakukan analisis sensitifitas dan spesifisitas. Kurva receiver operating characteristic (ROC) digunakan untuk memprediksi faktor risiko gagal napas. Analisis multivariat menggunakan uji regresi logistik untuk menilai hubungan faktor klinis gawat napas dengan gagal napas. Nilai p<0.05 dianggap bermakna secara statistik.Hasil: Dari 158 pasien probable dan konfirmasi COVID-19 dengan gawat napas, didapatkan 47(29.7%) pasien gagal napas dalam observasi 14 hari perawatan. Seluruh pasien datang dengan kesadaran penuh Glasgow Coma Scale 15, median frekuensi napas 22x/menit (17-30) dengan nilai potong 20x/menit, pasien dengan frekuensi napas >20x/menit memiliki OR 1,3 (1,08-1,54 IK95%, nilai p <0,01), median frekuensi nadi 89x/menit (60-136) dengan nilai potong 90x/menit, pasien dengan frekuensi nadi >90x/menit memiliki OR 1,04 (1,01-1,06 IK95%, nilai p 0,02), median mean arterial pressure 93 (71-97) dengan nilai potong 74 mmHg, median saturasi oksigen 98% (91-100) dengan nilai potong 91% dan penggunaan otot bantu napas memiliki OR 0,53 (0,04-6,32 IK 95%, nilai p 0,62). Kesimpulan: Pasien gawat napas yang datang ke IGD dengan frekuensi pernapasan >20x/menit dan atau dengan frekuensi nadi >90x/menit memiliki risiko gagal napas.

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Background: Respiratory failure is one of complication in COVID-19, leading to mortality and morbidity. Patient who come to emergency department if didn’t give early treatment they could fall into respiratory failure. The purpose of this study was to evaluate risk factors of respiratory failure in probable and confirmed COVID-19 patients with respiratory distress at emergency department.

Method: This is prospective cohort study based on patient with respiratory distress who come to emergency departement of Persahabatan Hospital Jakarta. Sampling was done by consecutive sampling in the period September 2020 until Oktober 2020. We measured clinical factor of respiratory distress that are consciousness, respiratory status (respiratory rate, oxygen saturation), cardiovascular status (mean arterial pressure, heart rate) and accessory muscle use in admission then observed if respiratory failure occur during 14 days. Clinical factors cut-off determine with area under curve (AUC) curve then test the sensitifity and specificity. Receiver operating characteristic (ROC) curve used to predict risk factors of respiratory failure. Multivariate analysis used to search relationship between clinical factors of respiratory distress with occurrence of respiratory failure. P value <0.05 statistically significant.

Results: Of 158 probable and confirmed patients with respiratory distress, there are 47 (27%) prevalence of respiratory failure in 14 days observation. Whole patient came with unconsciousness Glasgow Coma Scale 15, median of respiratory rate 22x/minute (17-30) by cut-off 20x/minute, patient with respiratory rate >20x/minute have OR 1.3 (1.08-1.54 IC95%, p<0.01), median of heart rate 89x/minute (60-136) by cut-off 90x/minute, patient with heart rate >90x/minute have OR 1.04 (1.01-1.06 IC95%, p 0.02), median of mean arterial pressure 93 (71-97) by cut-off 74 mmHg, median of oxygen saturation 98% (91-100) by cut–off 91%, accessory muscle use have OR 0.53 (0.04-6.32 IC95%, p 0.62).

Conclusion: Patient with respiratory distress who come to emergency department with respiratory rate >20x/minute and or heart rate >90x/minute have a risk of respiratory failure."

"Pendahuluan: Tuberkulosis resistan obat (TB RO) merupakan masalah kesehatan global dan sebagai hambatan dalam upaya pengendalian tuberkulosis (TB) di dunia. Infeksi sekunder adalah infeksi yang terjadi pada saat terinfeksi kuman lain atau sedang dalam terapi untuk jenis kuman lain. Infeksi sekunder pada pasien TB dapat disebabkan oleh banyak faktor yang mempengaruhi imunitas individu. Koinfeksi dengan organisme lain dapat berperan dalam progresivitas TB dan mempengaruhi luaran terapi TB. Data mengenai pola mikroorganisme pasien TB RO dengan infeksi saluran napas bawah di Indonesia.Tujuan: Untuk mengetahui pola mikroorganisme pada pasien TB RO dengan infeksi saluran napas bawah dan faktor-faktor yang mempengaruhinya.Metode: Analisis observasional kohort retrospektif kohort di RS Rujukan Respirasi Nasional Persahabatan, Jakarta Indonesia secara total sampling diperoleh dari Januari 2018 hingga Desember 2018. Kami meninjau rekam medis 84 pasien dengan diagnosis TB RO dengan infeksi saluran napas bawah dan 66 status rekam medis yang memenuhi kriteria inklusi.Hasil: Sebanyak 66 pasien yang termasuk dalam penelitian ini 65,2% infeksi saluran napas bawah bronkiektasis terinfeksi. Status HIV reaktif berhubungan dnegan kejadian infeksi saluran napas bawah pada pasien TB RO (p=0,001). Gangguan fungsi ginjal dan gangguan fungsi hati juga berhubungan bermakna dengan kejadian infeksi saluran napas bawah (p=0,041 dan p=0,046). Klebsiella pneumonia adalah mikroorganisme terbanyak yaitu 15,2%. Kuman multidrug resistant obat (MDRO) ditemukan sebanyak 56% dengan mikroorganisme MDRO terbanyak adalah Acinetobacter baumanii. Waktu konversi sputum memiliki rerata 2,96 ± 1,83 bulan. Kematian < 30 hari ditemukan sebanyak 30,3% dan ada hubungan yang bermakna antara infeksi saluran napas bawah dan kematian < 30 hari pada pasien TB RO (p=0,025).Kesimpulan: Infeksi saluran napas bawah pada TB RO yang paling banyak adalah bronkiektasis terinfeksi dengan pola mikroorganisme gram negatif serta kuman MDRO banyak ditemukan. Kejadian infeksi saluran napas bawah berhubungan bermakna terhadap kematian < 30 hari pada pada pasien TB RO.

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Introductions: Secondary lower respiratory tract infection (LRTI) in drug-resistant (DR) tuberculosis (TB) patients may alter disease progression and therapy outcomes. Specimen microorganism patterns of the lower respiratory tract from DR-TB patients in Indonesia is yet to be known.

Aims: To identify the specimen microorganism patterns of the lower respiratory tract from DR-TB patients and the factor that influenced it.

Methods: We performed a retrospective cohort analysis of DR-TB patients with LRTI treated in National Respiratory Referral Persahabatan Hospital Jakarta, Indonesia, between January and December 2018. We reviewed the records of 84 DR-TB patients with LRTI. The subjects were 66 patients who met the inclusion criteria.

Results: Most subjects (65.2%) were co-diagnosed with infected bronchiectasis. Factors related to LRTI in DR-TB were the detection of human immunodeficiency virus (HIV) antigen (p=0.002) and impaired renal function (p=0.041) and liver function (p=0.046) from the blood test. The microorganism patterns found in the specimens were multidrug-resistant (MDR) (56.0%), which Klebsiella pneumonia (15.2%) and Acinetobacter baumanii (9.1%) predominated. The average sputum conversion time of subjects was 2.96±1.83 months. The <30 days-mortality was found in 30.3% subjects and was correlated with LRTI (p=0.025).

Conclusions: The most common LRTI in DR-TB was infected bronchiectasis. The most common specimen microorganism pattern in DR-TB was MDR Gram- negative microorganisms. This study showed a correlation between LRTI and the

<30 days-mortality in DR-TB."