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"Latar Belakang Coronavirus disease 2019 (COVID-19) adalah penyakit pernapasan yang disebabkan oleh virus SARS-CoV-2. Pasien COVID-19 tahap berat-kritis sering memerlukan terapi oksigen dengan ventilator. Salah satu variabel penting pada ventilator adalah positive end-expiratory pressure (PEEP) yang berfungsi mencegah kolaps alveoli, menjaga paru-paru tetap terbuka, dan meningkatkan pertukaran gas. Nilai PEEP optimal disarankan berada pada 6—12 cmH2O dan pada pasien COVID-19 berat-kritis, PEEP tinggi direkomendasikan untuk mencapai target SpO2 92—96%. Namun, PEEP terlalu tinggi justru dapat memberi efek buruk. Penelitian terkait penggunaan PEEP pada pasien COVID-19 di Indonesia belum banyak tersedia. Oleh karena itu, penelitian ini dilakukan di RSUP Persahabatan untuk menilai peran PEEP dalam perbaikan oksigenasi pada pasien COVID-19 derajat berat-kritis setelah 24 jam penggunaan ventilator. Metode Penelitian ini merupakan penelitian deskriptif analitik dengan desain kohort retrospektif. Penelitian ini menggunakan data sekunder rekam medis yang diolah dengan uji Gamma untuk menilai hubungan korelasi nilai PEEP dengan perbaikan oksigenasi pasien COVID-19, beserta variabel gas darah lain, yang dipasang ventilator. Hasil Dari hasil analisis 43 rekam medis, didapatkan hubungan nilai PEEP dengan nilai pH (p = 0.326), nilai PaO2 (p = 0.012), nilai SaO2 (p = 0.147), nilai PCO2 (p = 0.062), dan dengan rata-rata nilai PEEP 8.3 cmH2O. Kesimpulan Tidak ditemukan hubungan yang signifikan antara nilai PEEP dan perbaikan oksigenasi pasien COVID-19 yang dipasang ventilator jika dilihat dari nilai SaO2, begitu juga pH, dan PCO2. Namun, hubungan signifikan didapatkan antara nilai PEEP dengan perbaikan oksigenasi yang dilihat dari nilai PaO2.

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Introduction Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the SARS-CoV-2 virus. COVID-19 patients in severe-critical stages often require oxygen therapy through ventilators. One important variable in a ventilator is positive end-expiratory pressure (PEEP), which helps prevent alveolar collapse, keeps the lungs open, and enhances gas exchange. Optimal PEEP values are suggested to be between 6–12 cmH2O, while high PEEP is recommended for severe-critical COVID-19 patients to reach an SpO2 target of 92–96%. However, excessively high PEEP may have adverse effects. Research on PEEP use in COVID-19 patients in Indonesia is still scarce. Therefore, this study was conducted at RSUP Persahabatan to assess the role of PEEP in improving oxygenation in severe-critical COVID-19 patients after 24 hours of ventilator use. Method This study is a descriptive-analytic study with a retrospective cohort design. This study utilizes secondary data through medical records which are analyzed with the Gamma test to assess the correlation between PEEP values and oxygenation improvement in ventilated COVID-19 patients, along with other blood gas variables. Results Analysis of 43 medical records revealed a correlation between PEEP values and pH (p = 0.326), PaO2 (p = 0.012), SaO2 (p = 0.147), and PCO2 (p = 0.062), with an average PEEP value of 8.3 cmH2O. Conclusion There was no significant correlation between PEEP values and oxygenation improvement in ventilated COVID-19 patients based on SaO2, pH, and PCO2. However, a significant correlation was found between PEEP values and oxygenation improvement based on PaO2."

"ABSTRAKLatar Belakang. Atelektasis merupakan komplikasi pernapasan perioperatif yang sering terjadi hingga 24 jam pascaoperatif, namun dapat bertahan hingga beberapa hari. Penggunaan PEEP dapat membuka alveolus yang kolaps pascaoperatif. Penelitian ini berusaha membandingkan efek PEEP 5 cmH20 dan 10 cmH2O terhadap distribusi ventilasi pada pasien pascaoperatif menggunakan EIT.Metoda. Uji klinis acak ini dilakukan di RS Cipto Mangunkusumo terhadap 35 pasien operasi kranioktomi dan laparotomi elektif (usia 18-60 tahun, durasi bedah > 3 jam, paru normal). Subjek dirandomisasi ke dalam 2 kelompok intervensi: ventilasi mekanik pascaoperatif PEEP 5 cmH20 (PEEP-5) dan PEEP 10 cmH2O (PEEP-10). Hipotesis penelitian adalah distribusi ventilasi PEEP-10 lebih baik dibandingkan PEEP-5. Parameter ∆TIV, ∆EELI (global dan regional) dan CR diambil dari monitor EIT PulmoVista 500®.Hasil. Nilai ∆TIV antara bagian paru anterior dan posterior berbeda bermakna secara statistik pada menit ke-20 (p=0,012), namun masih ada subjek kelompok PEEP-5 dengan distribusi ventilasi tidak homogen hingga 1 jam pengukuran. Nilai ∆EELI global dan regional dalam 1 jam secara statistik bermakna dengan nilai p<0,05. Nilai ∆CR (anterior dan posterior) bermakna secara statistik (p=0,000) dalam 1 jam. Tidak ditemukan perbedaan ratio PF, lama intubasi dan lama rawat di UPI. Tidak ditemukan komplikasi paru/ekstraparu lain dan mortalitas.Simpulan. Distribusi ventilasi berdasarkan gambaran EIT antara penggunaan PEEP 10 cmH2O dan PEEP 5 cmH2O tidak berbeda secara statistik dalam 1 jam penggunaan ventilasi mekanik pascaoperatif. Distribusi ventilasi hanya bermakna secara statistik pada menit ke-20. pernapasan perioperatif

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ABSTRACTBackground. Atelectasis is the most common perioperative respiratory complications up to 24 hours postoperatively, but can last up to several days. PEEP can open postoperative alveolar collapse. We determined to compare the effect of PEEP 5 cmH20 and 10 cmH2O on distribution of ventilation in patients postoperatively using EIT.Method. This randomized clinical trial conducted in Cipto Mangunkusumo Hospital to 35 patients underwent elective craniotomy and laparotomy (18-60 years of age, surgery> 3 hours, normal lung). Subjects were randomized into two intervention groups: postoperative mechanical ventilation PEEP 5 cmH20 (PEEP-5) and 10 cmH2O PEEP (PEEP-10). The hypothesis is distribution of ventilation PEEP-10 is better than PEEP-5. Parameter ΔTIV, ΔEELI (global and regional) and ΔCR were taken from a monitor EIT PulmoVista 500®.Results. ΔTIV values ​​between anterior and posterior parts of lung statistically significant difference in the 20th minute (p=0.012), but there is still a subject of the PEEP group-5 which has a non-homogeneous distribution of ventilation up to 1 hour of measurement. The value of ΔEELI (global and regional ) in 1 hour statistically significant with p <0.05. ΔCR value (anterior and posterior) was statistically significant (p = 0.000) in 1 hour. No differences found for PF ratio, length of intubation and duration of hospitalization in ICU. No pulmonary/extrapulmonaary complications and mortality were found.Conclusion. Distribution of ventilation based EIT imaging between the use of PEEP 10 cmH2O and PEEP 5 cmH2O do not differ statistically within 1st hour of the postoperative mechanical ventilation. Distribution of ventilation is statistically significant only in the 20th minute.;Background. Atelectasis is the most common perioperative respiratory complications up to 24 hours postoperatively, but can last up to several days. PEEP can open postoperative alveolar collapse. We determined to compare the effect of PEEP 5 cmH20 and 10 cmH2O on distribution of ventilation in patients postoperatively using EIT.Method. This randomized clinical trial conducted in Cipto Mangunkusumo Hospital to 35 patients underwent elective craniotomy and laparotomy (18-60 years of age, surgery> 3 hours, normal lung). Subjects were randomized into two intervention groups: postoperative mechanical ventilation PEEP 5 cmH20 (PEEP-5) and 10 cmH2O PEEP (PEEP-10). The hypothesis is distribution of ventilation PEEP-10 is better than PEEP-5. Parameter ΔTIV, ΔEELI (global and regional) and ΔCR were taken from a monitor EIT PulmoVista 500®.Results. ΔTIV values ​​between anterior and posterior parts of lung statistically significant difference in the 20th minute (p=0.012), but there is still a subject of the PEEP group-5 which has a non-homogeneous distribution of ventilation up to 1 hour of measurement. The value of ΔEELI (global and regional ) in 1 hour statistically significant with p <0.05. ΔCR value (anterior and posterior) was statistically significant (p = 0.000) in 1 hour. No differences found for PF ratio, length of intubation and duration of hospitalization in ICU. No pulmonary/extrapulmonaary complications and mortality were found.Conclusion. Distribution of ventilation based EIT imaging between the use of PEEP 10 cmH2O and PEEP 5 cmH2O do not differ statistically within 1st hour of the postoperative mechanical ventilation. Distribution of ventilation is statistically significant only in the 20th minute.;Background. Atelectasis is the most common perioperative respiratory complications up to 24 hours postoperatively, but can last up to several days. PEEP can open postoperative alveolar collapse. We determined to compare the effect of PEEP 5 cmH20 and 10 cmH2O on distribution of ventilation in patients postoperatively using EIT.Method. This randomized clinical trial conducted in Cipto Mangunkusumo Hospital to 35 patients underwent elective craniotomy and laparotomy (18-60 years of age, surgery> 3 hours, normal lung). Subjects were randomized into two intervention groups: postoperative mechanical ventilation PEEP 5 cmH20 (PEEP-5) and 10 cmH2O PEEP (PEEP-10). The hypothesis is distribution of ventilation PEEP-10 is better than PEEP-5. Parameter ΔTIV, ΔEELI (global and regional) and ΔCR were taken from a monitor EIT PulmoVista 500®.Results. ΔTIV values ​​between anterior and posterior parts of lung statistically significant difference in the 20th minute (p=0.012), but there is still a subject of the PEEP group-5 which has a non-homogeneous distribution of ventilation up to 1 hour of measurement. The value of ΔEELI (global and regional ) in 1 hour statistically significant with p <0.05. ΔCR value (anterior and posterior) was statistically significant (p = 0.000) in 1 hour. No differences found for PF ratio, length of intubation and duration of hospitalization in ICU. No pulmonary/extrapulmonaary complications and mortality were found.Conclusion. Distribution of ventilation based EIT imaging between the use of PEEP 10 cmH2O and PEEP 5 cmH2O do not differ statistically within 1st hour of the postoperative mechanical ventilation. Distribution of ventilation is statistically significant only in the 20th minute."

"Particulate matter merupakan salah satu kontaminan udara yang dihasilkan oleh industri semen. Pajanan jangka panjang ataupun jangka pendek PM2,5 mengakibatkan efek kesehatan, salah satunya gangguan fungsi pernapasan. Penelitian ini bertujuan untuk menggambarkan konsentrasi pajanan personal PM2,5 dan efek akut pernapasan subyektif pada pekerja patrol bagian produksi di industri semen PT X, tahun 2016. Penelitian ini merupakan penelitian kuantitatif dengan desain deskriptif . Pengukuran konsentrasi PM2,5 menggunakan Leland Legacy Pump dan Sioutas Cascade Impactor selama 8 jam kerja pada patroler area reklamer, raw mill, firing, finish mill, dan packhouse. Hasil penelitian menunjukkan rata-rata konsentrasi pajanan personal PM2,5 pada patroler industri semen PT X adalah 1495,651 µg/m3 dan konsentrasi pajanan PM2,5 tertinggi terdapat pada area packhouse. Seluruh patroler mengalami efek akut pernapasan subyektif, dengan keluhan tertinggi sakit tenggorokan dan bersin (64,7%).

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Particulate matter is one of the air contaminant produced by cement industry. Health effect that caused by long term or short term of PM2,5 exposure lead to respiratory diseases. This study purposes to describe personal exposure concentrations of particulate matter (PM2,5) and percentage subjective acute respiratory effects on production patrol workers at PT X cement industry 2016. This research is a quantitative descriptive study by measuring the concentration of PM2,5 using personal sampling equipment such as Leland Legacy Pump and Sioutas Cascade Impactor during work hours on patrol reklamer, raw mill, firing, finish mill, and pack house work area. The result shown that the average personal exposure concentration of PM2,5 on patrol workers in PT X cement industry amounted to 1495,651 µg/m3 with the highest area of exposure in the pack house work area. All of patrol workers experienced the subjective acute respiratory effects with the highest effect are sore throat and sneezing (64,7%)."

"Tatalaksana tindakan invasif berupa pemasangan ETT dan ventilator dalam pemenuhan kebutuhan oksigenasi pasien secara tidak langsung akan berdampak pada keamanan dan kenyamanan fisiologis pasien. Hal ini terjadi karena adanya peningkatan tekanan reflek faring dan laring serta penurunan reflek batuk pasien yang berakibat adanya akumulasi sekret berlebih sebagai penyebab terjadinya iritasi/trauma mekanis dan peningkatan resiko VAP pada pasien. Tindakan clapping dan suction yang dilakukan merupakan beberapa upaya rehabilitative dalam meminimalisir dampak negatif yang muncul.  Tujuan penelitian ini adalah untuk mengetahui perbedaan pengaruh clapping + suction dan suction terhadap saturasi oksigen dan kenyamanan pada pasien yang terpasang ventilator di ruang intensive. Sampel dalam penelitian ini berjumlah 36 responden yang dibagi menjadi 18 responden kelompok intervensi 1 (clapping dan suction) dan 18 responden kelompok intervensi 2 (suction). Metode  penelitan ini adalah quasy eksperiment dengan desain Pre test and post test pada kedua kelompok intervensi. Hasil penelitian ini menunjukan terdapat perbedaan yang bermakna  terhadap parameter SpO2 pasien pada kelompok intervensi 1 dan kelompok intervensi 2 (p value 0, 029 ) dimana pada pada kelompok intervensi 1 memiliki perubahan skor rerata lebih tinggi dibanding pada kelompok intervensi 2, sedangkan pada parameter kenyamanan pasien tidak ada perbedaan yang signifikan antara kelompok intervensi 1 dan kelompok intervensi 2 ( p value 0, 078 ). Dengan tindakan clapping dan suction akan memaksimalkan airway pasien dalam meningkatkan status oksigenasi dan fungsi fisiologis paru pasien. Hasil dari penelitian ini diharapkan menjadi suatu gold standar baru berupa pemberian intervensi clapping dan suction khususnya pada pasien dengan penggunaan ventilator diruang intensive.

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Management of invasive measures in the form of ETT and ventilator installation in meeting the patient's oxygenation needs will indirectly have an impact on the safety and physiological comfort of the patient. This is due to an increase in pharyngeal and laryngeal reflex pressure and a decrease in the patient's cough reflex which results in the accumulation of excess secretions as a cause of mechanical irritation/trauma and an increased risk of VAP in patients. The clapping and suction actions taken are some of the rehabilitative efforts in minimizing the negative impacts that arise. The purpose of this study was to determine the difference in the effect of clapping + suction and suction on oxygen saturation and comfort in patients who are on a ventilator in the intensive care unit. The sample in this study amounted to 36 respondents who were divided into 18 respondents in the intervention group 1 (clapping and suction) and 18 respondents in the intervention group 2 (suction). This research method is a quasi-experimental design with pre-test and post-test in both intervention groups. The results of this study indicate that there is a significant difference in the SpO2 parameter of patients in the intervention group 1 and intervention group 2 (p value 0.029) where the intervention group 1 has a higher mean score change than in the intervention group 2, while the patient comfort parameter there was no significant difference between intervention group 1 and intervention group 2 (p value 0.078). Clapping and suctioning will maximize the patient's airway in improving the oxygenation status and physiological function of the patient's lungs. The results of this study are expected to become a new gold standard in the form of providing clapping and suction interventions, especially in patients using ventilators in the intensive room."

"ABSTRAKNama : Subhan RumoningProgram Studi : Ilmu Penyakit DalamJudul : Durasi Operasi sebagai Prediktor Komplikasi Paru Pasca Operasi Non Kardiak di RSCM Latar belakang : Di Indonesia, sebanyak 18,4 pasien yang menjalani operasi non-kardiak di RSUPN Cipto Mangunkusumo Indonesia mengalami Komplikasi Paru Pasca Operasi Post-operative Pulmonary Complication/PPC . Beberapa penelitian menunjukkan durasi operasi memiliki hubungan dengan PPC. Penelitian ini bertujuan untuk mengetahui peranan durasi operasi sebagai prediktor kejadian komplikasi gagal napas dan pneumonia dalam 30 hari pasca operasi. Metode : Penelitian menggunakan desain kohort retrospektif pada November 2016-Juli 2017 dengan data rekam medis pasien yang menjalani operasi di RSUPN Cipto Mangunkusumo tahun 2012-2016. Sampel penelitian diambil dengan metode consecutive sampling yang memenuhi kriteria inklusi dan eklusi, dilihat luarannya selama 30 hari pasca operasi. Hasil : Dari 102 pasien diketahui 58,8 perempuan, 35,5 41-50 tahun, 25,5 berpendidikan SMA, 34,3 tidak bekerja, 77,5 tidak mengalami penurunan berat badan, 80,4 tidak merokok, tidak ada yang memiliki riwayat PPOK, 61,8 anestesi umum, 64,7 operasi elektif dan 51,96 lokasi operasi di abdomen. Didapatkan 10,8 mengalami gagal napas dan 6,9 mengalami pneumonia. Dari analisis bivariat, durasi operasi tidak dapat digunakan sebagai prediktor kejadian gagal napas p 0,106; RR 3,56; CI 95 0,885 -14,280 maupun pneumonia p 0,701; RR 1,61; CI 95 0,342-7,601 . Kesimpulan : Durasi operasi tidak dapat digunakan sebagai prediktor tunggal dalam memprediksi kejadian komplikasi gagal napas maupun pneumonia pasca operasi.

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ABSTRACTABSTRACT Name Subhan Rumoning Study Program Internal MedicineTitle Duration of Surgery as a Predictor of Post operative Pulmonary Complications in Non cardiac Surgeries at RSCM Background In Indonesia, 18.4 patient done non cardiac surgery at RSUPN Cipto Mangunkusumo Indonesia had Post operative Pulmonary Complications PPC . Studies shown that duration of surgery associated with PPC. This study aims to know the role of duration of surgery as a predictor of respiratory failure and pneumonia in post operative patient during 30 days after surgery. Method This cohort retrospective study were conducted from November 2016 until July 2017 using medical records of patients who underwent surgery at RSUPN Cipto Mangunkusumo from 2012 until 2016. Samples were taken by consecutive sampling which fulfilled inclusion and exclusion criteria, and being followed up until 30 days after surgery. Result From 102 patients, 58.8 were females, 35.5 were 41 50 years old, 25.5 were high school graduated, 34.3 were not employed, 77.5 weren rsquo t having any weight reduction, 80.4 not smoking, none had COPD, 61.8 underwent general anesthesia, 64.7 underwent elective surgery and 51,96 operation site in abdomen. From all samples, 10.8 had respiratory failure and 6.9 had pneumonia. From bivariate analysis, duration of surgery can rsquo t be a predictor of either with respiratory failure p 0,106 RR 3,56 CI 95 0,885 14,280 or pneumonia p 0,701 RR 1,61 CI 95 0,342 7,601 . Conclusion . Duration of surgery can rsquo t be a single predictor to predict respiratory failure and pneumonia as PPC"

"Latar Belakang: Gagal napas merupakan suatu sindrom pada sistem pernapasan yang gagal dalam fungsi pertukaran gas, sehingga menyebabkan hipoksemia dan/atau hiperkapnia. Pasien dengan gagal napas sangat memerlukan penggunaan ventilator mekanik. Terdapat hubungan antara malnutrisi dengan gagal napas. Terapi medik gizi pasien sakit kritis berupa nutrisi enteral dini dapat menjadi strategi terapi yang dapat mengurangi ketergantungan pada ventilator, mengurangi komplikasi, menurunkan lama rawat di ICU dan meningkatkan keluaran klinis pasien.Metode: Serial kasus ini melaporkan empat pasien sakit kritis dengan gagal napas yang dirawat di ICU RSUPNCM. Terapi medik gizi diberikan sesuai pedoman pada sakit kritis. Nutrisi enteral dini diberikan dalam 48 jam perawatan di ICU. Tiga pasien dapat mencapai target energi 25-30 kkal/kg BB, dan minimal protein 1,2 g/kg BB, sedangkan 1 pasien dengan obes I hanya dapat mencapai energi <70% dari kebutuhan energi total dan protein 0,6 g/kg BB. Mikronutrien diberikan dalam makanan cair. Volume makanan cair yang diberikan disesuaikan dengan imbang cairan pasien setiap hari.Hasil: Pasien pada serial kasus ini berusia 44-67 tahun, semua adalah laki-laki. Satu pasien dengan status gizi malnutrisi ringan, 2 pasien berat badan normal dan 1 pasien dengan obes 1. Dua dari empat pasien termasuk gagal napas tipe I akibat gagal jantung kongestif dengan edema paru. Dua pasien lainnya termasuk gagal napas tipe II akibat fasitis nekrotikan. Seluruh pasien mendapatkan nutrisi enteral dalam 48 jam pertama perawatan. Satu pasien dengan malnutrisi ringan, dan hipoalbuminemia berat mengalami perawatan >21 hari karena sulit weaningventilator dan masuk sebagai chronically crtically ill sedangkan tiga lainnya dengan BB normal dan obes mengalami <21 hari perawatan.Kesimpulan: Status gizi memengaruhi lama pemakaian ventilator mekanik. Terapi medik gizi dapat diterapkan pada semua pasien sesuai dengan komorbid dan dapat mendukung perbaikan keluaran klinis pasien.

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Background: Respiratory failure is a respiratory system syndrome of inadequate gas exchange, resulting hypoxemia and/or hypercapnia. Respiratory failure patient needs mechanical ventilation as the main therapy. Malnutrition and respiratory failure are related. Early enteral nutrition is a therapeutic strategy that can reduce dependence on mechanical ventilation, complications, length of stay in ICU and improve clinical outcomes in critically ill respiratory failure patients.

Methode: This case series report four critically ill patients with respiratory failure from the ICU of Cipto Mangunkusumo Hospital. Medical nutrition therapy is implemented according to the ESPEN clinical nutrition guideline in critically ill. Early enteral nutrition is given in 48 hours of ICU care. Three patients can reach the energy target of 25-30 kcal/kg ABW, and a minimum of 1.2 g/kg ABW protein, whereas 1 obese patient can only achieved <70% of estimated TEE and protein needs of 0.6 g/kg IBW. Micronutrients given within enteral formula. The volume of enteral nutrition is adjusted to patient's fluid balance every day.

Result: Patients were 44-67 years old, all males. One patient was with mild malnutrition, 2 patients were in normal weight and 1 patient was obese I. Two of them were diagnosed as respiratory failure type I due to congestive heart failure with pulmonary edema. The two others were respiratory failure type II due to necrotizing fasciitis. All patients received early enteral nutrition within 48 hours. One patient with malnutrition and severe hypoalbuminemia stayed for >21 days in ICU for mechanical ventilation need, and become a chronically crtically ill while others are <21 days.

Conclusion: Nutritional status affects mechanical ventilation dependence. Medical nutrition therapy can be applied to all patients according to their comorbidities and can improve clinical outcomes. "

"Latar Belakang: Infeksi severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pada pasien lansia sering berkembang menjadi berat dengan tingkat kematian yang tinggi. Tes laboratorium yang dapat digunakan sebagai prediktor keparahan dan kematian COVID-19 tidak spesifik dan sering dijumpai pada kondisi lainnya. Penelitian tentang hubungan antara nilai cycle threshold (CT) awal uji polymerase chain reaction (PCR) dengan kejadian gagal nafas dan kematian saat perawatan pada pasien lansia yang terinfeksi SARS-CoV-2 belum ada. Penelitian yang melaporkan cut-off nilai CT yang dapat digunakan untuk interpretasi atau stratifikasi risiko pada pasien lansia juga belum ada.Tujuan: Membuktikan peran nilai CT awal uji PCR untuk memprediksi kejadian gagal nafas dan kematian saat perawatan pada pasien lansia terkonfirmasi COVID-19.Metode: Penelitian ini merupakan suatu kohort retrospektif yang melibatkan pasien lansia terkonfirmasi COVID-19 yang dirawat di Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo (RSCM) Jakarta periode Juni 2020 sampai Desember 2021. Kriteria inklusi adalah pasien berusia ≥ 60 yang tahun memiliki diagnosis COVID-19 kasus konfirmasi dan terdapat hasil nilai CT awal uji PCR di dalam rekam medis. Kriteria eksklusi adalah rekam medis tidak ditemukan atau data tidak lengkap, pasien sudah gagal nafas atau meninggal saat datang, pasien pulang paksa atau pindah rumah sakit.Hasil: Penelitian ini melibatkan 543 subyek dengan median usia 67,59 tahun (rentang interkuartil [RIK] 63,12-73,35), sebanyak 55,6% subyek berjenis kelamin laki-laki dan 50,6% subyek memiliki dua atau lebih komorbiditas. Komorbiditas yang paling sering ditemui adalah hipertensi (55,1%), DM (39,6%), penyakit ginjal kronis (15,3%), penyakit jantung koroner (15,1%) dan kanker (10,3%). Median nilai CT awal uji PCR pada kelompok yang mengalami gagal nafas lebih rendah (23,76 vs. 28,07), p<0,001. Cut-off terbaik dari nilai CT awal uji PCR untuk memprediksi gagal nafas adalah 23,8 (sensitivitas 51,0% dan spesifisitas 76,4%). Median nilai CT awal uji PCR pada kelompok yang meninggal lebih rendah (23,55 vs. 28,14), p<0,001. Cut-off terbaik dari nilai CT awal uji PCR untuk memprediksi kematian adalah 25 (sensitivitas 60,3% dan spesifisitas 70,0%).Simpulan: Nilai CT awal uji PCR yang rendah merupakan prediktor tingginya kejadian gagal nafas dan kematian saat perawatan pada pasien lansia terkonfirmasi COVID-19 dengan nilai cut-off 23,8 dan 25 secara berturut-turut.

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Background: Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in elderly is often severe with a high mortality rate. Laboratory tests are not specific for predicting severity and mortality of COVID-19 and are common in other conditions. There is no study on the relationship between polymerase chain reaction (PCR) cycle threshold (CT) value with respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19. CT value-based risk stratification or interpretation in elderly is also limited by the absence of CT cut-off values.

Objective: This sudy aims to determine the role of initial PCR CT value to predict respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19.

Methods: This retrospective cohort study utilised data of elderly inpatients with confirmed COVID-19 in Cipto Mangunkusumo Hospital, Indonesia’s national general hospital from June 2020 to December 2021. The inclusion criterion was complete data of initial PCR CT value in medical records from elderly inpatients aged 60 years and older with confirmed COVID-19. Exclusion criteria were incomplete data or no medical records found, those who had respiratory failure or deceased on arrival, those who was forced dicharged or moved to another hospital.

Results: A total of 543 elderly patients were enrolled in this study. Among all, the median age was 67.59 years (interquartile range (IQR) 63.12-73.35); 55.6% patients were men and 50.6% patients had two or more comorbidities. The common comorbidities were hypertension (55,1%), diabetes mellitus (39,6%), chronic kidney disease (15,3%), coronary heart disease (15,1%) and cancer (10,3%) The median CT value of group with acute respiratory distress syndrome (ARDS) was lower (23.76 vs. 28.07), p<0.001. The best cut-off for predicting ARDS was 23.8 (sensitivity of 51.0% and specificity of 76.4%). The median CT value of non-survivor group was lower (23.55 vs. 28.14), p<0.001. The best cut-off for predicting ARDS was 25 (sensitivity of 60.3% and specificity of 70.0%).

Conclusions: A low PCR CT value is a predictor of high respiratory failure and mortality in hospitalized elderly patients with confirmed COVID-19, the best cut-off was 23.8 and 25 respectively. "

"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."

"ABSTRAKTerapi oksigen hiperbarik (TOH) telah direkomendasikan sebagai terapi adjuvan dari terapi utama steroid pada tuli mendadak, dengan mekanisme peningkatan oksigenasi jaringan dan penekanan inflamasi dan edema akibat iskemia. Belum didapatkan penelitian tentang perbandingan ambang perfrekuensi dan signal to noise ratio (SNR) antara terapi steroid metil prednisolon (MP) dibanding kombinasi MP dan TOH pada tuli mendadak. Penelitian uji klinis acak tersamar tunggal ini dilakukan di Poliklinik Neurotologi Departemen THT-KL FKUI/RSCM dan Unit Hiperbarik RSAL Mintohardjo pada bulan Juni-Desember 2013, melibatkan 20 subjek tuli mendadak, dengan 10 subjek kelompok terapi MP dan 10 subjek kelompok terapi MP dan TOH. Analisis dilakukan pada pemeriksaan audiometri nada murni pada 9 frekuensi dan Distortion Product Otoacoustic Emission (DPOAE) pada 5 frekuensi, pada awal terapi dan hari ke-15. Penelitian ini tidak mendapatkan perbedaan perubahan ambang perfrekuensi dan SNR yang bermakna secara statistik antara kedua kelompok, didapatkan kecenderungan perubahan ambang perfrekuensi yang lebih besar pada frekuensi 1000, 2000, 4000, 10000, 12000 dan 16000 Hz pada kelompok MP dan TOH, dan perubahan SNR yang lebih besar pada frekuensi 12000 Hz pada kelompok MP dan TOH. Tidak didapatkannya perbedaan perubahan ambang perfrekuensi dan SNR yang bermakna, dimungkinkan karena penelitian ini merupakan penelitian pendahuluan. Penelitian juga membatasi analisis hingga terapi hari ke-15, sedangkan subjek tuli mendadak di Poli Neurotologi THT-KL RSCM sedianya dilanjutkan evaluasi hingga hari ke-90 (3 bulan). Penelitian lebih lanjut dengan besar subjek yang sesuai serta waktu evaluasi yang lebih lama, diharapkan dapat lebih menganalisis kecenderungan perubahan ambang perfrekuensi dan SNR yang lebih besar pada kelompok MP dan TOH.

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ABSTRACTHyperbaric oxygen therapy (HBOT) has been recommended as an adjuvant therapy of primary steroid therapy in sudden deafness, the mechanism by increasing of tissue oxygenation and suppression of inflammation and edema due to ischemia. Differences in frequency threshold and signal to noise ratio changes between methyl prednisolone (MP) therapy with MP and HBOT on sudden deafness, has not been obtained. This single-blind randomized clinical trial study was conducted at the Neurotology clinic of CMH ENT Department and Hyperbaric Unit of Mintohardjo Navy Hospital in June-December, 2013, involving 20 sudden deafness subjects, with 10 subjects in MP therapy group and 10 subjects in MP and HBOT group. Analysis was performed on pure tone audiometric examination at 9 frequencies and Distortion Product Otoacoustic Emission (DPOAE) at 5 frequencies, at the start of therapy and day 15. This study does not get the statistically significant difference in frequency threshold and SNR changes between the two groups, it was found that the tendency of changes in frequency threshold was greater in frequencies 1000, 2000, 4000, 10000, 12000 and 16000 Hz in the MP and HBOT group, and the change in SNR was greater in frequency of 12000 Hz in the MP and HBOT group. The statistically significant difference in frequency threshold and SNR changes between the two groups does not obtained, possible because this study is preliminary research. The study also restrict the analysis to the 15th day of therapy, while the subject of sudden deafness in Neurotology Clinic of CMH ENT Department originally continued evaluation until the 90th day (3 months). Further studies with larger appropriate subject and a longer evaluation period, is expected to further analyze trends and greater changes in frequency threshold and SNR in the MP and HBOT gorup."

"Latar Belakang: Coronavirus Disease 2019 (COVID-19) merupakan penyakit saluran pernafasan yang menjadi pandemi dasawarsa terakhir dan dapat menyebabkan disfungsi jantung. Galectin-3 diduga terkait dengan proses inflamasi yang berlanjut pada remodelling dan akhirnya fibrosis organ. Diharapkan penilaian terhadap Galectin-3 akan memperoleh gambaran perburukan jantung pasien COVID-19 sehingga diperoleh data faktor-faktor yang berpengaruh terhadap peningkatan Left Ventricular End Diastolic Volume (LVEDV) yang nantinya menjadi gagal jantung pada pasien COVID-19.Metode: Rancangan penelitian ini adalah observasional prospektif analitik di ICU COVID-19 RSUP Sanglah. Penelitian dilakukan sejak bulan Juni sampai Oktober 2021. Semua subjek penelitian diperiksa kadar Galectin-3 menggunakan pemeriksaan Enzyme-Linked Immunosorbent Assay (ELISA). Subjek juga dilakukan evaluasi Left Ventricular End Diastolic Volume (LVEDV) dengan ekokardiografi, diidentifikasi menggunakan skor SOFA saat di ICU COVID-19, serta pemeriksaan terhadap kadar Troponin I. Subjek penelitian tetap akan mendapat terapi COVID-19 sesuai dengan protokol standar Kementerian Kesehatan RI. Setelah 72 jam pasca admisi ICU COVID-19, subjek penelitian akan dilakukan pemeriksaan ulangan terhadap kadar Galectin-3 dan LVEDV. Data yang didapatkan dianalisis dengan uji statistik menggunakanSTATATM.Hasil: Didapatkan total 45 subjek penelitian. Dari hasil analisis bivariat terhadap selisih Galectin-3 dengan LVEDV didapatkan tidak signifikan (r=0,08), uji korelasi antara Galectin-3 dan LVEDV saat masuk ruang rawat ICU ternyata tidak signifikan (r=0,191), dan korelasi antara Galectin-3 dan LVEDV pasca rawat 72 jam juga tidak signifikan (r=0,197). Dari hasil multivariat variabel bebas yakni selisih Galectin-3, usia, jenis kelamin, troponin I, skor SOFA dan CHARLSON terhadap variabel LVEDV ternyata tidak ada satu pun variabel yang memiliki hasil yang bermakna secara statistik (p<0,05) terhadap LVEDV.Simpulan: Tidak ada korelasi antara Galectin-3 dengan peningkatan LVEDV dalam penelitian ini

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Background: Coronavirus Disease 2019 (COVID-19) is a respiratory disease that has become the largest pandemic and also could put heart at risk of dysfunction. Galectin-3 is thought to be related to the inflammatory process that continues with remodeling and eventually fibrosis. By using Galectin-3 assesment, we could overview the possible worsening of the heart and evaluate data on influencing factors in increased Left Ventricular End Diastolic Volume (LVEDV) which could later become heart failure.

Methods: This is an observational prospective analytic study in the COVID-19 ICU of Sanglah Hospital. The study was started from June to October 2021. All research subjects will have their blood samples taken for Galectin-3 levels using Enzyme-Linked Immunosorbent Assay (ELISA). Subjects were also evaluated for Left Ventricular End Diastolic Volume (LVEDV) with echocardiography, identified using SOFA scores, and also examined their Troponin I levels. Subjects were treated with COVID-19 standard protocol from the Health Ministry. After 72 hours post-admission, subjects were re-examined for Galectin-3 levels and LVEDV. The data were analyzed by statistical tests using STATATM.

Results: A total of 45 research subjects were analysed. Bivariate analysis of the difference of Galectin-3 and LVEDV shown to be insignificant (r=0.08), no correlation was found between Galectin-3 level and LVEDV while admitted to the ICU (r=0.191), and no correlation found between Galectin-3 level and LVEDV after 72 hours of hospitalization (r=0.197). Multivariate analysis also showed that none of variables namely difference of Galectin-3 level, age, gender, troponin I, SOFA and CHARLSON had statistically significant results (p<0.05) on LVEDV.

Conclusions: No correlation was found between Galectin-3 level and an increase in LVEDV."