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"The most severe clinical feature of COVID-19 is Acute Respiratory Distress Syndrome (ARDS) which requires intubation and mechanical ventilation and it occurs in approximately 2.3% of cases. About 94% of these cases end in death. This case series report two confirmed COVID-19 patients who had met criteria of intubation and mechanical ventilation, but not performed to them. Both patients experienced clinical improvement and recovery. This is probably due to differences of COVID-19 ARDS (CARDS) with typical or classic ARDS. CARDS is divided into two phenotypes of type L (Low Elastance) and type H (High Elastance). These different phenotypic also distinguish subsequent pathophysiology and clinical management. These phenotype can be differentiated by chest CT scan. This case series emphasizes the importance of understanding this phenotype so that clinicians can provide more appropriate treatment management and also availability of CT scans in health facilities that manage COVID -19."

"Latar Belakang. Bulan Maret 2020, World Health Organization mengumumkan Covid-19 sebagai sebuah pandemi global. Hingga saat ini, kasus Covid-19 masih terus bertambah dengan angka kematian mencapai lebih dari 590.000 kasus di seluruh dunia. Covid-19 terutama mempengaruhi sistem pernapasan menyebabkan pneumonia dan dapat secara cepat bertambah berat dan masuk ke dalam kondisi acute respiratory distress syndrome (ARDS). Tingginya kebutuhan bantuan ventilasi mekanis pada pasien Covid-19 dengan ARDS membuat para petugas medis harus terus mencari tatalaksana yang paling tepat, termasuk moda ventilasi mekanis yang cocok digunakan pada pasien Covid-19. Moda airway pressure release ventilation (APRV) terus berkembang dan pengunaannya terus bertambah, terutama dalam tatalaksana gagal napas dan ARDS. Pada laporan kasus berbasis bukti ini, kami membahas efektivitas APRV dibandingkan ventilasi mekanis konvensional dalam manajemen gagal napas pasien tersangka Covid-19 dengan komplikasi ARDS. Metode. Metode laporan kasus berbasis bukti ini mengikuti pedoman Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Pencarian sistematis dilakukan menggunakan database elektronik yaitu Pubmed®, Ebsco®, Cochrane Library® dan Science Direct® dengan menggunakan kata kunci airway pressure release ventilation, acute respiratory distress syndrome, dan Covid. Hasil. Tiga artikel dengan desain studi randomized control trials (RCT) dan satu artikel studi observasional retrospektif didapatkan dari hasil pencarian. Keempat artikel menunjukkan adanya peningkatan rasio PaO2/FiO2 setelah intervensi dan dua artikel menyimpulkan bahwa APRV diasosiasikan dengan berkurangnya lama rawat di ICU. Simpulan. Pada kasus pasien Covid-19 dengan komplikasi ARDS (tipe H), APRV dapat menjadi alternatif moda ventilator yang dapat digunakan sebagai tatalaksana bantuan ventilasi mekanis meskipun APRV tidak dapat dikatakan lebih efektif dibandingkan moda ventilator konvensional.

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Background. In March 2020, World Health Organization (WHO) stated that Covid-19 was a global pandemic. Currently, the number of case is still inclining with mortality rate more than 590,000 cases worldwide. This disease mainly affects the respiratory system that will lead to pneumonia, and quickly becoming worse so that will fall into acute respiratory distress syndrome (ARDS) condition. The high demand of mechanical ventilation in patients with Covid-19 and ARDS encourages medical workers to find the appropriate managements, including this mechanical ventilation mode. The airway pressure release ventilation (APRV) mode continuously develops and its utilization consistently increases, especially in the management of respiratory failure and ARDS. This evidence based case report elaborates the effectiveness of APRV compared to conventional mechanical ventilation in the management of respiratory failure in patients suspicious of Covid-19 with ARDS complications.

Methods. The method of this evidence based case report was performed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Systematic exploration was conducted through electronic database, such as Pubmed, EBSCO, Cochrane Library, and Science Direct, with airway pressure release ventilation, acute respiratory distress syndrome, and Covid as the keywords.

Results. There were 3 randomized control trials (RCT) and 1 observational study revealed to be relevant to this study. There 4 articles mentioned the increasing of PaO2/FiO2 ratio following intervention. Two of those studies also stated that APRV was associated with the shorter length of hospitalization in Intensive Care Unit (ICU).

Conclusion. In patients with Covid-19 and ARDS complication (type H), APRV can be an alternative ventilator mode to assist mechanical ventilation, although APRV cannot be said more effective than conventional ventilator mode."

"Pada tanggal 11 Maret 2020, WHO menetapkan COVID-19 sebagai pandemi di dunia. Dilansir dari situs covid19.who.int, per 19 Juni 2021 Indonesia berada di urutan ke-18 dan memiliki 1,963,266 kasus terkonfirmasi dengan total 54,043 pasien yang meninggal. Salah satu kasus berat atau termasuk dalam kelompok kritis adalah pasien dengan Acute Respiratory Distress Syndrom (ARDS). Melihat banyaknya kasus ARDS yang berakhir dengan kematian dan terbatasnya gambaran klinis terkait ARDS yang disebabkan oleh COVID-19 membuat penelitian ini berfokus untuk mengidentifikasi faktor risiko yang berasosiasi dengan kejadian ARDS pada pasien COVID-19. Faktor-faktor risiko kejadian ARDS pada pasien COVID-19 diidentifikasi dengan menggunakan metode classification tree dimana performa model diukur dari nilai akurasi, sensitivitas, spesifisitas, dan AUC. Cost matrix digunakan sebagai strategi rebalancing data. Besaran risiko relatif faktor-faktor tersebut terhadap ARDS akan dihitung dengan menggunakan metode regresi logistik. Model yang dihasilkan memiliki nilai akurasi, sensitivitas, spesifisitas, dan AUC masing-masing sebesar 0.879, 0.804, 0.900, dan 0.852. Pasien COVID-19 yang mengalami peningkatan kadar hemoglobin, PCO_2 dan CRP, penurunan kadar PCT, saturasi oksigen, dan urea, mengalami gejala sesak napas, dan memiliki komorbid pneumonia secara rata-rata memiliki risiko lebih tinggi untuk mengalami kejadian ARDS.

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On March 11, 2020, WHO declared COVID-19 as a worldwide pandemic. Reporting from the website covid19.who.int, as of June 19, 2021, Indonesia was in 18th place and had 1,963,266 confirmed cases with a total of 54,043 patients who died. One of the severe cases or included in the critical group was a patient with Acute Respiratory Distress Syndrome (ARDS). Seeing the large number of ARDS cases that ended in death and the limited clinical picture related to ARDS caused by COVID-19 made this research to be focused on identifying risk factors associated with ARDS incidence in COVID-19 patients. Identification of risk factors for the incidence of ARDS in COVID-19 patients using a classification method where the performance of the model is measured of the values of accuracy, sensitivity, specificity, and AUC. Cost matrix is used as a data rebalancing strategy. The relative risk of ARDS was calculated using the logistic regression method. The accuracy, sensitivity, specificity, and AUC obtained in the model are 0.879, 0.804, 0.900, and 0.852, respectively. COVID-19 patients who experienced increased hemoglobin, PCO_2, and CRP levels, decreased PCT levels, oxygen saturation, and urea, experienced symptoms of shortness of breath, and had pneumonia on average had a higher risk of developing ARDS."

"Luaran ibu dengan infeksi Covid-19 dikaitkan dengan tingkat keparahan penyakit dan peningkatan risiko komplikasi kehamilan. Penyebab mortalitas ibu dengan Covid-19 sangat bervariasi dan terbatas. Penelitian ini bertujuan untuk mengetahui penyebab kematian ibu dengan infeksi Covid-19 di RSUD Pasar Rebo.Penelitian terdiri dari 2 tahap. Tahap 1 merupakan systematic review untuk mendapatkan data penyebab kematian ibu dengan infeksi Covid-19. Tahap 2 merupakan studi deskriptif retrospektif dengan mengambil data rekam medis ibu dan wawancara pada keluarga ibu dengan infeksi Covid-19 yang meninggal di RSUD Pasar Rebo. Penelitian tahap 1 menemukan etiologi kematian ibu dengan infeksi Covid-19 adalah pneumonia, kegagalan multiorgan, serangan jantung dan DIC. Penelitian tahap 2 menemukan ibu dengan infeksi Covid-19 yang meninggal rerata berusia 29,25 tahun dengan masa gestasi 24-39 minggu dengan gejala klinis demam, batuk dan sesak. Komorbiditas adalah obesitas (2 dari 4 kasus), hipertensi (1 dari 4 kasus) dan preeklampsia (1 dari 4 kasus). Hampir semua kasus dirawat di ICU. Semua ibu dengan infeksi Covid-19 meninggal karena ARDS. Sumber infeksi ditemukan pada 2 dari 4 kasus. Seluruh kasus mengalami kesulitan dalam mencari fasilitas Kesehatan tempat rawat khusus Covid-19 untuk ibu hamil di beberapa tempat sebelum datang ke RSUD Pasar Rebo. Simpulan : Penyebab kematian ibu dengan infeksi Covid-19 adalah ARDS. Perlu mengidentifikasi ibu dengan infeksi Covid-19 yang memiliki komorbiditas atau komplikasi medis untuk penanganan lebih ketat dan memperbaiki sistem rujukan.

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Maternal outcomes with COVID-19 infection were associated with disease severity and an increased risk of pregnancy complications. The etiology of maternal mortality with Covid-19 are varied and limited. This study aimed to determine the etiology of maternal death with Covid-19 infection at Pasar Rebo Hospital.

The research consisted of 2 phases. Phase 1 was a systematic review to obtain data on etiology of maternal death with Covid-19 infection. Phase 2 was a retrospective descriptive study by taking maternal medical records and interviewing with the families of maternal with Covid-19 infection who died at Pasar Rebo Hospital.

Phase 1 research found the etiology of maternal death with Covid-19 infection was pneumonia, multiorgan failure, heart attack and DIC. Phase 2 research found mothers with Covid-19 infection who died an average age of 29.25 years with a gestation period of 24-39 weeks with clinical symptoms of fever, cough and shortness of breath. Comorbidities were obesity (2 out of 4 cases), hypertension (1 out of 4 cases) and preeclampsia (1 out of 4 cases). Almost all cases are admitted to the ICU. All mothers with Covid-19 infection died of ARDS. The source of infection was found in 2 out of 4 cases. All cases had difficulty finding health facilities for Covid-19 special care for pregnant women in several places before coming to Pasar Rebo Hospital

Conclusion : The cause of maternal death with Covid-19 infection is ARDS. It is important to identify mothers with Covid-19 infection who have comorbidities or medical complications for stricter treatment and improve the referral system."

"Pandemi COVID-19 yang berasal dari Kota Wuhan, Provinsi Hubei, China saat ini turut melanda Indonesia dengan angka kasus yang meningkat secara signifikan. COVID-19 diketahui menimbulkan komplikasi terhadap fungsi pernafasan. Salah satu di antara komplikasi yang disebabkan oleh COVID-19 adalah Acute Respiratory Distress Syndrome (ARDS). ARDS menimbulkan masalah keperawatan utama, yaitu gangguan pertukaran gas. Sehingga, pasien dengan masalah gangguan pertukaran gas membutuhkan intervensi keperawatan yang dapat membantu ventilasi-perfusi yang adekuat, salah satunya dengan penerapan pemberian posisi yang sesuai, seperti high-fowler. Tujuan penelitian adalah mengidentifikasi efektivitas penerapan pemberian posisi high-fowler pada pasien COVID-19 dengan ARDS. Pemberian posisi high-fowler dilakukan selama tiga hari dengan durasi 8 jam per hari pada pasien COVID-19 dengan ARDS di setting ruang high-care. Hasil menunjukkan perbaikan difusi alveolar paru yang adekuat berdasarkan indikator laju respirasi, saturasi oksigen, tidak adanya penggunaan otot bantu nafas dapat dipertahankan dalam batas normal. Penelitian ini diharapkan bermanfaat dalam memberikan intervensi keperawatan yang efektif untuk mengatasi gangguan pertukaran gas pada pasien COVID-19 dengan ARDS.

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The COVID-19 pandemic, which was obtained from Wuhan City, Hubei Province, China, is currently experiencing a significant increase in Indonesia. COVID-19 is known caused complication for respiratory function. One of complications that caused by COVID-19 is Acute Respiratory Distress Syndrome (ARDS). ARDS poses a major nursing problem, namely impaired gas exchange. Thus, patient with impared gas exchange problem require nursing interventions that can help reach adequate ventilation-perfusion, one of which is by applying appropriate positioning, such as high-fowler. The aim of the study is to identify the effectiveness of applying high-fowler positioning in COVID-19 patient with ARDS. The implementation of high-fowler positioning was carried out for three days with a duration 8-hours per day in COVID-19 patient with ARDS in high-care unit setting. The results show an adequate improvement in pulmonary alveolars diffusion based on indicator, such as respiration rate, oxygen saturation, absence the use of breath-assisted muscles can be maintained within normal limits. This research is expected to be useful in providing effective nursing interventions to overcome impaired gas exchange in COVID-19 patient with ARDS."

"ABSTRAKLatar Belakang: Angka mortalitas ARDS khususnya di RSCM masih tinggi, sebesar 75,3%. Prokalsitonin dan CRP bisa dipakai sebagai prediktor mortalitas pada ARDS. Saat ini belum didapatkan penelitian yang fokus pada peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di Indonesia.Tujuan: Mengetahui peran PCT dan CRP sebagai prediktor mortalitas tujuh hari pada pasien ARDS di RSCM.Metode: Penelitian ini menggunakan disain kohort prospektif yang dilakukan secara konsekutif pada pasien ARDS di RSCM, November 2015-Januari 2016. Saat pasien didiagnosis ARDS, dalam 6-24 jam dilakukan pemeriksaan PCT dan CRP, diobservasi selama tujuh hari, lalu dilakukan analisis statistik. Data kategorikal disajikan dalam jumlah dan persentase. Data numerik dengan sebaran tidak normal disajikan dalam bentuk median dan rentang. Variabel faktor-faktor yang memengaruhi mortalitas diuji dengan analisis bivariat (menggunakan uji Mann Whitney bila memenuhi persyaratan distribusi tidak normal). Untuk menentukan cutoff PCT dan CRP dipakai kurva ROC dengan mencari sensitivitas dan spesifisitas yang terbaik.Hasil: Dari 66 pasien ARDS, didapatkan 40 (60,61%) meninggal dan 26 (39,39%) hidup. Uji normalitas PCT dan CRP didapatkan distribusi dari data-data tersebut tidak normal. Dengan uji Kolmogorov-Smirnov didapatkan p<0,05. Median PCT pada yang meninggal sebesar 4,18 (0,08-343,0) dibandingkan yang hidup sebesar 3,01 (0,11-252,30) p=0,390, AUC 0,563 (IK 95% 0,423-0,703). Median CRP pada yang meninggal sebesar 130,85 (9,20-627,78) dibandingkan yang hidup sebesar 111,60 (0,10-623,77) p=0,408, AUC 0,561 (IK 95% 0,415-0,706).Simpulan: Pemeriksaan PCT dan CRP hari pertama pada penelitian ini belum dapat digunakan sebagai prediktor mortalitas tujuh hari pada pasien ARDS.Kata kunci: ARDS, CRP, mortalitas, PCT

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ABSTRACTBackground: The mortality rate of ARDS, specifically in RSCM is still high, that is of 75.3%. Procalcitonin and CRP can be used as mortality prediktor on ARDS. Until today there is no research focusing in the role of PCT and CRP as seventh day mortality predictor on ARDS patients in Indonesia.Objectives: To identify the role of PCT and CRP as mortality predictors on seventh day of ARDS patients in RSCM.Methods: This research used a prospective cohort design that was done consecutively on ARDS patients in RSCM during November 2015 to January 2016. When a patient was diagnosed with ARDS, within the next 6-24 hours, the PCT and CRP test were run and an observation was done for seven days, and a statistical analysis followed after. The categorical data descriptions are presented in numbers and percentage. Numerical data with abnormal distribution are presented in the forms of medians and spans. The variables of the factors that influence mortality were tested by using bivariate analysis (using Mann Whitney’s test whenever they met the conditions of abnormal distribution). To determine the PCT and CRP cutoff (values), the ROC curve is used to search for the best sensitivity and specificity.Results: Out of the 66 patients ARDS, 40 (60.61%) died and 26 (39.39%) survived. The PCT and CRP normality tests results obtained from the distribution of those data are not normal. By using the Kolmogorov-Smirnov the value of p<0.05 was obtained. The PCT median on those who died is 4.18 (0.08-343.0) compared to those who survived that is 3.01 (0.11-252.30) p=0.390, AUC 0.563 (CI 95% 0.423-0.703). CRP median on those who died is 130.85 (9.20-627.78) compared to those who survived that is 111.60 (0.10-623.77) p=0,408, AUC 0.561 (CI 95% 0.415-0.706).Conclusions:, The PCT and CRP tests on first day in this research are not yet available to be used as mortality predictor on seventh day of ARDS patients.Key words : ARDS, CRP, mortality, PCT"

"ABSTRAKLatar Belakang : Acute respiratory distresss syndrome (ARDS) merupakan salah satu kegawatan di bidang pulmonologi yang angka mortalitasnya sangat tinggi. Untuk menurunkan mortalitas pasien ARDS perlu diketahui faktor-faktor yang mempengaruhinya. Studi-studi tentang faktor faktor yang mempengaruhi mortalitas pasien ARDS masih menunjukkan hasil yang berbeda-beda, dan saat ini beada penelitian yang komprehensif di Indonesia khususnya di RSCM.Tujuan : Mengetahui faktor-faktor yang mempengaruhi mortalitas pasien ARDS yang dirawat di RSCM.Metode : Penelitian ini merupakan studi kohort retrospektif pada pasien ARDS yang dirawat di RSCM selama tahun 2008–2012. Data klinis, laboratorium, expertise foto toraks beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel usia, etiologi ARDS, indeks komorbiditas Charlson, rasio PaO2/FiO2, skor APACHE II, dan penggunaan ventilator dalam 48 jam sejak diagnosis ARDS. Variabel yang memenuhi syarat akan disertakan pada analisis multivariat dengan regresi logistik. Hasil : Sebanyak 368 pasien diikutsertakan pada penelitian ini. Didapatkan angka mortalitas selama perawatan sebesar 75,3%. Faktor usia, etologi ARDS (sepsis, non sepsis), indeks komorbiditas Charlson , skor APACHE II, dan penggunaan ventilator dalam 48 jam sejak diagnosis ARDS merupakan variabel yang berbeda bermakna pada analisis bivariat. Faktor-faktor yang mempengaruhi mortalitas pada analisis multivariat adalah sepsis sebagai penyebab ARDS (RR 1,26; IK 95% 1,20 sampai 1,32; p < 0,001), skor APACHE II yang tinggi (RR 1,19; IK 95% 1,03 sampai 1,30; p = 0.019) dan tidak menggunakan ventilator dalam 48 jam sejak diagnosis ARDS (RR 1,37; IK 95% 1,25 sampai 1,43; p <0,001).Kesimpulan: ARDS yang penyebabnya sepsis, skor APACHE II yang tinggi, dan tidak menggunakan ventilator dalam 48 jam sejak diagnosis ARDS merupakan faktor independen yang mempengaruhi mortalitas pasien ARDS.

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ABSTRACTBackground : Acute respiratory distress syndrome (ARDS) is an emergency in pulmonology field that contributes to high mortality rate. To decrease the mortality rate of ARDS patients we need to identify factors affecting it. Studies about factors affecting ARDS mortality showed varying results and until now there is still no comprehensive study about it in Indonesia especially in RSCM hospital.Aim : To know factors affecting mortality of ARDS patients in Cipto Mangunkusumo Hospital.Methods : This study was a retrospective cohort on ARDS patients who were hospitalized in Cipto Mangunkusumo hospital from 2008 to 2012. Data about clinical condition, laboratory, chest X-ray, and outcome of hospitalization were all collected from medical records. Bivariate analyses were performed on age, ARDS etiology, comorbidity Charlson index, PaO2/FiO2 ratio, APACHE II score, and ventilator use in the first 48 hours since ARDS diagnosed. Multivariate with logistic regression would be done to variables that fulfilled the condition.Results : As many as 368 patients were included in this study. Inhospital mortality was 75.3%. On bivariate analysis we found that age, ARDS etiology, comorbidity Charlson index, PaO2/FiO2 ratio, APACHE II score, and ventilator use in the first 48 hours since ARDS diagnosed were variables that had significant associations with inhospital mortality. From multivariate analysis, we found variables that had associations with mortality were sepsis as ARDS etiology (RR 1.26; 95% CI 1.20-1.32; p < 0.001), the high APACHE II score (RR 1.19; 95% CI 1.04-1.30; p = 0.019) , and no ventilator use in the first 48 hours since ARDS diagnosed (RR 1.37; 95% CI 1.25-1.43; p < 0.001).Conclusion : Sepsis as ARDS etiology, the high APACHE II score , and no ventilator use in the first 48 hours since ARDS diagnosed were independent factors affecting ARDS patients mortality."

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Acute Respiratory Distress Syndrome (ARDS) merupakan kondisi paru yang memicu respon inflamasi sistemik dengan etiologi yang berbeda yang memiliki ciri-ciri klinis patologis khas. Penelitian ini menganalisis tentang pemberian posisi prone dan reverse trendelenburg 30 derajat sebagai terapi suportif untuk meningkatkan status oksigenasi pada pasien ARDS serta bagaimana dampaknya terhadap komplikasi edema wajah dan Gastric Residual Volume (GRV). Tujuan penelitian untuk mengetahui pengaruh pemberian posisi prone dan reverse trendelenburg 30 derajat terhadap parameter oksigenasi, edema wajah dan GRV. Desain penelitian dengan menggunakan quasi experiment design melalui pendekatan crossover trial design dengan 11 responden. Analisis data menggunakan uji independent t-test pada data terdistribusi normal dan Mann Whitney pada data terdistribusi tidak normal dan jenis data kategorik. Tidak terdapat perbedaan rata-rata yang signifikan pada parameter oksigenasi; saturasi oksigen (p value 0,685), PaO2/FiO2 rasio (p value 0,358), SpO2/FiO2 rasio (p value 0,850), maupun EtCO2 (p value 0,409) dan edema wajah (p value 0,403) antar kelompok prone dengan kelompok prone dan reverse trendelenburg 30 derajat, namun terdapat perbedaan rata-rata yang signifikan pada variabel GRV antara kelompok prone dengan kelompok prone dan reverse trendelenburg 30 derajat (p value 0,035). Kesimpulan: baik posisi prone maupun posisi prone dengan reverse trendelenburg 30 derajat sama-sama memberikan dampak yang positif pada parameter oksigenasi. Namun kedua posisi ini juga memberikan dampak yang patut diwaspadai terkait kejadian edema wajah dan peningkatan GRV, dengan angka kejadian yang lebih rendah pada pemberian posisi prone dengan reverse trendelenburg 30 derajat.

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Acute Respiratory Distress Syndrome (ARDS) is a pulmonary condition that triggers a systemic inflammatory response with different etiologies that has typical pathological clinical characteristics. This study analyzes the provision of 30 degrees prone and reverse Trendelenburg positions as supportive therapy to improve oxygenation status in ARDS patients and its impact on complications of facial edema and Gastric Residual Volume Gastric Residual Volume (GRV). The aim of the research is to determine the effect of 30 degrees prone and reverse trendelenburg positions on oxygenation parameters, facial edema and GRV. The research design used a quasi experimental design using a crossover trial design approach with 11 respondents. Data analysis used the independent t test on normally distributed data and Mann Whitney on non-normally distributed data and categorical data types. There were no significant average differences in oxygenation parameters; oxygen saturation (p value 0.685), PaO2/FiO2 ratio (p value 0.358), SpO2/FiO2 ratio (p value 0.850), as well as EtCO2 (p value 0.409) and facial edema (p value 0.403) between the prone group and the prone group and reverse trendelenburg, there is a significant average difference in the GRV variable between the prone group and the prone and reverse trendelenburg 30 degrees groups (p value 0.035). Conclusion: the prone position and the prone position with reverse trendelenburg 30 degrees both have a positive impact on oxygenation parameters. However, these two positions also have an impact that is worth paying attention to regarding the incidence of facial edema and increased GRV, with a lower incidence rate in the prone position with reverse Trendelenburg 30 degrees.

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"Ventilasi mekanik dengan intubasi endotrakeal merupakan terapi suportif bagi penderita Acute Respiratory Distress Syndrome (ARDS). Penggunaan ventilator akan menyebabkan mekanisme utama pembersihan sekresi terganggu. Multimodalitas fisioterapi adalah istilah untuk serangkaikan teknik (perkusi, vibrasi, kompresi, positioning, hiperoksigenasi, suction, dan latihan ekstremitas) sebagai intervensi asuhan keperawatan pada pasien dengan bersihan jalan napas tidak efektif untuk meningkatkan pembersihan sekresi saluran napas sehingga mencegah komplikasi terhadap penggunaan ventilator. Evalusai harian dilakukan dengan pemantauan status respirasi, pengeluaran sekret, skoring RSBI, dan skoring CPIS. Hasil implementasi multimodalitas fisioterapi menunjukkan intervensi ini dapat meningkatkan SpO2, meningkatkan pengeluaran sekret dan karakteristik sekret yang lebih baik, keberhasilan dalam proses penyapihan ventilator, mempercepat ekstubasi, dan mencegah terjadinya Ventilator Associated Pneumonia (VAP). Penulis merekomendasikan perawat dapat menggunakan multimodalitas fisioterapi pada salah satu tindakan rutin di ICU pasien yang terpasang ventilator.

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Mechanical ventilation with endotracheal intubation are supportive therapy for sufferers of Acute Respiratory Distress Syndrome (ARDS). The use of a ventilator will cause the main mechanism for cleaning secretions to be disrupted. Multimodality physiotherapy is a term for a series of techniques (percussion, vibration, compression, positioning, hyperoxygenation, suction, and extremity exercises) as a nursing care intervention for patients with ineffective airway clearance to increase clearance of airway secretions thereby preventing complications with ventilator use. Daily evaluation is carried out by monitoring respiratory status, secretion output, RSBI scoring, and CPIS scoring. The results of the implementation of multimodality physiotherapy show that this intervention can increase SpO2, increase secretion output and better secretion characteristics, success in the ventilator weaning process, speed up extubation, and prevent the occurrence of Ventilator Associated Pneumonia (VAP). The author recommends that nurses use multimodality physiotherapy as one of the routine procedures in the ICU for patients who are on a ventilator."

"COVID-19 adalah penyakit yang disebabkan oleh Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) yang telah ditetapkan sebagai pandemik sejak tanggal 11 Maret 2020 oleh World Health Organization (WHO). Diketahui bahwa paru-paru yang terinfeksi langsung oleh virus dapat mengakibatkan manifestasi klinis berupa pneumonia virus. Sistem kekebalan tubuh dapat mengalami perubahan imunologis dalam tubuh seperti leukopenia, limfopenia, dan inflamasi badai sitokin, sehingga dapat menyebabkan peningkatan risiko infeksi lainnya. Maka dari itu, diperlukan adanya Pemantauan Terapi Obat (PTO) untuk mengoptimalkan efek terapi dan menekan angka morbiditas pasien COVID-19. Pada penulisan ini akan dibahas mengenai PTO pada pasien COVID-19 dengan pneumonia, hipokalemia berulang, dan anemia defisiensi zat besi di ruangan Melati COVID di RSUD Tarakan, Jakarta. Hal ini diharapkan dapat menggambarkan peran apoteker klinis dalam Pemantauan Terapi Obat sehingga mampu meminimalisasi risiko masalah terkait obat, progresivitas penyakit, serta dapat meningkatkan kualitas hidup pasien. Pengambilan data dilakukan dengan pemantauan data rekam medik pasien dari sejak pertama kali masuk rumah sakit hingga pasien dapat dipulangkan. Selanjutnya, dilakukan penetapan asesmen dan rencana yang akan didiskusikan bersama apoteker penanggung jawab ruangan tersebut. Hasil analisis PTO yang dilakukan terhadap pasien tersebut ialah terdapat satu obat yang tidak tepat dosis, yaitu urotractin. Selain itu, terdapat masalah terkait kegagalan penerimaan vitamin C yang diresepkan dan interaksi antarsuplemen kalsium karbonat dan vitamin D3 yang dapat meningkatkan risiko hiperkalsemia pada pasien.

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COVID-19 is a disease caused by Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) which has been comes up as a pandemic since March 11, 2020 by World Health Organization (WHO). It is known that lungs directly infected by viruses can result in clinical manifestations in the form of viral pneumonia. The immune system can experience immunological changes in the body such as leukopenia, lymphopenia, and inflammatory cytokine storms, which can cause an increased risk of other infections. Therefore, there is a need for Monitoring Drug Therapy (MDT) to optimize the therapeutic effect and reducing the morbidity rate of COVID-19 patients. In this article, we will discuss MDT in COVID-19 patients with pneumonia, recurrent hypokalemia, and iron deficiency anemia in the Melati COVID room at Tarakan Hospital, Jakarta. It is hoped that this will illustrate the role of clinical pharmacists in MDT so that they can minimize the risk of drug-related problems (DRPs), disease progression, and can improve the patient's quality of life. Data collection is carried out by monitoring the patient's medical record data from the time they are first admitted to the hospital until the patient can be discharged. Next, an assessment and plan is carried out which will be discussed with the pharmacist in charge of the room. The results of the MDT analysis carried out on this patient were that one drug was not dosed correctly, urotractin. In addition, there are problems related to failure to receive prescribed vitamin C and interactions between calcium carbonate and vitamin D supplements which can increase the risk of hypercalcemia in patients.

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