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Abstrak :
ABSTRAK
Latar 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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ABSTRACT
Background: 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

Abstrak :
Tujuan: mengetahui kesintasan jangka pendek dalam 28 hari pada pasien acute respiratory distress syndrome (ARDS). Metode: studi retrospektif dilakukan di rumah sakit pusat rujukan tersier di Jakarta, Indonesia. Pada studi ini, digunakan data rekam medis yang diambil selama 10 bulan, yaitu Oktober 2015 hingga Agustus 2016. Keluaran primer studi ini adalah kesintasan jangka pendek selama 28 hari terhitung sejak pasien didiagnosis sebagai ARDS. Hasil yang didapatkan kemudian dianalisis menggunakan Kaplan-Meier dan analisis multivariat Cox regresi. Hasil: studi ini mendapatkan 101 pasien ARDS dalam periode 10 bulan. Kesintasan keseluruhan selama 28 hari adalah 47.5% dan nilai median adalah 10 hari (95% CI 2.47 ? 17.52). Kesintasan pada pasien ARDS cenderung menurun signifikan pada minggu pertama setelah didiagnosis ARDS. Hal itu menunjukkan mortalitas tertinggi terjadi pada minggu pertama. Skor APACHE II >20 menunjukkan HR 2.45 (95% CI 1.40- 4.28) dan derajat ARDS moderat-berat menunjukkan HR 2.27 (95% CI 1.25-4.12). Kesimpulan: kesintasan jangka pendek di negara berkembang seperti Indonesia masih rendah dan manajemen yang optimal pada awal dari minggu pertama pada pasien ARDS akan memperbaiki tingkat kesintasan.

Aim: to identify the 28-day short-term survival rate in patients with acute respiratory distress syndrome (ARDS). Methods: this is a retrospective cohort study conducted at a tertiary referral hospital in Jakarta, Indonesia. We conducted the study for 10 months and data was extracted from medical records between October 2015 and August 2016. The primary end point of the study was 28-day short-term survival rate using the initial date of ARDS diagnosis as the index time. Overall survival rate was analyzed using Kaplan-Meier test and multivariate Cox regression analysis. Results: there were 101 ARDS subjects during 10 months of study. The overall rate of 28-day survival was 47.5% and the median time of survival was 10 days (95% CI 2.47?17.52). The survival rate in ARDS patients was reduced significantly at the first week after the diagnosis of ARDS was made, which indicated that the highest mortality occured in the first week. Subjects with APACHE II score of >20 had a hazard ratio (HR) of 2.45 (95% CI 1.40-4.28) and those with moderate-severe of ARDS had HR of 2.27 (95% CI 1.25-4.12). Conclusion: the short-term survival rate of ARDS in developing countries including Indonesia is still low and early management with optimal treatment provided within the first week may improve the survival rate.

Abstrak :
ABSTRAK
Latar Belakang: Angka mortalitas ARDS khususnya di RSCM masih tinggi, sebesar 75,3%. Prokalsitonin (PCT) dan C-reactive protein (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 pada November 2015-Januari 2016. Hasil: Dari 66 pasien ARDS, 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.

Abstrak :
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.

Abstrak :
Latar belakang: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) adalah virus menyebabkan infeksi saluran pernafasan dan memiliki manifestasi klinis ringan sampai berat serta dapat menyebabkan kematian. Tingginya angka morbiditas dan mortalitas akibat infeksi COVID 19 menyebabkan diperlukannya stratifikasi resiko terhadap pasien saat masuk ke rumah sakit serta prediktor terjadinya luaran buruk pada pasien. Tujuan: Mengetahui kemampuan skor mortalitas 4C dan kadar leptin dalam memprediksi luaran buruk pasien COVID 19 terkonfirmasi selama perawatan. Metode: Penelitian ini merupakan kohort prospektif dari 375 pasien COVID-19 yang dirawat di RSUPN Cipto Mangunkusumo sejak November 2020 hingga April 2021. Pasien dilakukan pemeriksaan fisik, CRP, Ureum  serta pemeriksaan kadar leptin saat admisi. Dilakukan analisis multivariat regresi logistik untuk menilai kemampuan skor mortalitas 4C dan leptin untuk memprediksi luaran buruk komposit yang mencakup ARDS dan mortalitas. Analisis korelasi dan regresi linier dengan STATA 15. Hasil: Dari analisis data pada 375 pasien didapatkan skor mortalitas 4C dapat memprediksi luaran buruk pasien COVID 19 selama rawat inap dengan area under curve (AUC) 0,68 (IK 0,61-0,75) dan titik potong skor mortalitas 4C adalah 6. Dari analisis multivariat didapatkan leptin tidak dapat memprediksi luaran buruk pasien COVID 19 selama rawat inap dengan area under curve (AUC) 0,52 (IK 0,44-0,60). Kesimpulan: Skor mortalitas 4C mampu memprediksi luaran buruk pasien COVID 19 terkonfirmasi selama perawatan sedangkan leptin tidak mampu menjadi prediktor luaran buruk pasien COVID 19 selama perawatan. ......Background:  The high morbidity and mortality rates due to COVID-19 infection require risk stratification for patients when admitted to the hospital as well as predictors of poor patient outcomes. While obesity has been reported to be associated with poor outcomes, the role of leptin, a proinflammatory cytokines released by the adipose tissue, has never been assessed. Objective: To determine the ability of the leptin levels and 4C mortality score to predict poor outcomes in confirmed COVID-19 patients. Method: This study is a prospective cohort of 375 COVID-19 patients treated at Cipto Mangunkusumo National Referal Hospital from November 2020 to April 2021, as part of the CARAMEL study. Subjects who were 18 years old and above and had confirmed COVID-19 status through COVID-19 polymerase chain reaction (PCR) from oropharyngeal swabs were included. Subjects when admitted to the hospital required non-invasive ventilation, mechanical ventilation, ECMO and those who refused to participate in the study were excluded. A multivariate logistic regression analysis was performed to assess the ability of the 4C mortality score and leptin to predict composite adverse outcomes, including ARDS and mortality. Results: Our study observed that while the 4C mortality score could predict poor outcomes for COVID-19 patients during hospitalization with an AUC of 0.68 (CI 0.61-0.75), leptin levels could not predict poor outcomes [(AUC of 0.52 (CI 0.44-0.60)]. Conclusion: Leptin levels were not associated with the development of poor outcomes in hospitalised Covid-19 patients.

Abstrak :
Ventilasi mekanik digunakan pada pasien ARDS ( Acute Respiratory distress syndrome) akibat Covid-19 di ruang Intensive Care Unit ( ICU). Salah satu intervensi yang direkomendasikan untuk meningkatkan saturasi oksigen yaitu dengan posisi prone. Metode yang digunakan berupa laporan kasus yang telah dikelola selama 4 hari pada pasien terdiagnosa positif Covid-19 yang dirawat di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dengan penyakit komorbid jantung dan terpasang ventilasi mekanik. Hasil menunjukkan bahwa terdapat peningkatan saturasi oksigen sebesar (11%) pada hari pertama, (8%) pada hari kedua, dan penurunan oksigen pada alat ventilasi mekanik sebesar (14%) dan peningkatan kadar oksigen pada hasil analisa gas darah sebesar 21mmhg. Kesimpulannya, prone position dapat meningkatkan saturasi oskigen pada pasien yang terpasang ventilasi mekanik, dan merupakan rekomendasi intervensi yang murah dan efektif ......Mechanical ventilation is used in ARDS (acute respiratory distress syndrome) patients due to Covid-19 in the Intensive Care Unit (ICU). One of the recommended interventions to increase oxygen saturation is the prone position. The method used is a case report that has been managed for 4 days in patient diagnosed as positive for Covid-19 at Jantung dan Pembuluh Darah Harapan Kita Hospital with comorbid heart disease and mechanical ventilation installed. The result showed that there was an increase in oxygen saturation (11%) on first day, (8%) on the second day, and a decrease in oxygen on mechanical ventilation devices by 14% and an increase in oxygen levels on the results of blood gas analysis by 21 mmhg. In conclusion, the prone position can increase oxygen saturation in mechanically ventilated patients, and is a recommended inexpensive and effective intervention.

Abstrak :
Coronavirus disease 19 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has been a problem worldwide, particularly due to the high rate of transmission and wide range of clinical manifestations. Acute respiratory distress syndrome (ARDS) and multiorgan failure are the most common events observed in severe cases and can be fatal. Cytokine storm syndrome emerges as one of the possibilities for the development of ARDS and multiorgan failure in severe cases of COVID-19. This case report describes a case of a 53-year-old male patient who has been diagnosed with COVID-19. Further evaluation in this patient showed that there was a marked increase in IL-6 level in blood accompanied with hyperferritinemia, which was in accordance with the characteristic of cytokine storm syndrome. Patient was treated with tocilizumab, a monoclonal antibody and is an antagonist to IL-6 receptor. The binding between tocilizumab and IL-6 receptors effectively inhibit and manage cytokine storm syndrome. Although this case report reported the efficacy of tocilizumab in managing cytokine storm syndrome, tocilizumab has several adverse effects requiring close monitoring. Further clinical randomized control trial is required to evaluate the efficacy and safety of tocilizumab administration in participants with various clinical characteristics and greater number of subjects.

Abstrak :
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.

Abstrak :

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.

Abstrak :
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. ......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.