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"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."

"Latar belakang. Acute respiratory distress syndrome (ARDS) merupakan salah satu komplikasi fatal sepsis berat. Penggunaan cairan koloid sebagai cairan resusitasi dapat menurunkan kejadian ARDS lebih banyak karena memiliki berat molekul yang lebih tinggi dibandingkan cairan kristaloid. Peningkatan extravascular lung water (EVLW), kadar interleukin-8 (IL-8) dan vascular cell adhesion molecule-1 (VCAM-1) telah diteliti sebagai indikator penting yang berperan dalam patogenesis ARDS. Penelitian pada hewan coba diharapkan dapat memberikan penjelasan yang lebih baik mengenai patofisiologi ARDS yang kompleks dan sulit dimengerti. Tujuan. Mengungkap pengaruh cairan koloid atau kristaloid terhadap kejadian ARDS pada model hewan coba babi dengan sepsis berat, serta menganalisis pengaruh cairan kristaloid atau koloid terhadap peningkatan EVLW, IL-8, dan VCAM-1. Metode. Penelitian ini merupakan studi eksperimental acak tersamar ganda, dilakukan di Laboratorium Bedah Eksperimental, Fakultas Kedokteran Hewan, Institut Pertanian Bogor, dengan menggunakan babi (Sus scrofa) yang sehat berusia 2-3 bulan, berat badan 8-12 kg. Subjek dialokasikan secara acak menjadi dua kelompok, yaitu yang mendapatkan cairan resusitasi koloid atau kristaloid. Setelah pemberian endotoksin 50 μg/kg, tanda klinis ARDS, EVLW, IL-8, dan VCAM-1 dipantau saat sepsis, sepsis berat, 1 jam, dan 3 jam pasca-resusitasi cairan. Tiga jam pasca-resusitasi, dilakukan eutanasia pada babi, kemudian spesimen jaringan paru diambil untuk pemeriksaan histopatologi. Hasil Utama. ARDS kategori ringan lebih banyak terdapat pada kelompok koloid, sedangkan ARDS kategori sedang lebih banyak pada kelompok kristaloid. Rerata skor cedera paru pada kelompok koloid lebih rendah dibandingkan dengan kristaloid (0,4 vs. 0,7; p=0,001). Peningkatan EVLW lebih sedikit terjadi pada kelompok koloid dibandingkan dengan kristaloid pada 1 jam (1,0 vs. 3,0 mL/kgbb; p=0,030) dan 3 jam pasca-resusitasi (2,7 vs. 6,3 mL/kgbb; p=0,034). Pada kedua kelompok, kadar IL-8 meningkat secara bermakna setelah pemberian endotoksin (103,1 vs. 3854,5 pg/mL; p=0,012 pada kelompok koloid dan 125,0 vs. 4419,3 pg/mL; p=0,003 pada kelompok kristaloid). Nilai kadar IL-8 dan VCAM-1 tidak berbeda bermakna antara kedua kelompok. Simpulan. Penggunaan cairan koloid sebagai cairan resusitasi tidak menurunkan kemungkinan kejadian ARDS dibandingkan kristaloid. Cairan koloid berhubungan dengan peningkatan EVLW dan skor cedera paru yang lebih rendah dibandingkan dengan cairan kristaloid, tetapi tidak pada kadar IL-8 dan VCAM-1.

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Background. Acute respiratory distress syndrome (ARDS) is a fatal complication of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid resuscitation may be associated with fewer cases of ARDS compared to crystalloids. Extravascular lung water (EVLW) elevation and levels of interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been studied as indicators playing a role in the pathogenesis of ARDS. The use of animal models may provide a better understanding of the complex and poorly understood pathophysiology of ARDS.

Objectives. To determine the effects of colloid or crystalloid fluid resuscitation on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1, in swine models with severe sepsis.

Methods. This was a randomized trial conducted at the Laboratory of Experimental Surgery, School of Veterinary Medicine, Institut Pertanian Bogor, using healthy swine (Sus scrofa) models aged 2 to 3 months with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration of 50 μg/kgbw of endotoxin, clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Three hours after resuscitation, euthanasia was performed on the animal and the lung tissue specimen was taken for histopathological examination.

Results. Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. Mean lung injury score was lower in colloid compared to crystalloid group (0.4 vs. 0.7; p=0.001). The increase in EVLW was lower in the colloid compared to the crystalloid group both at one hour (1.0 vs. 3.0 mL; p=0.030) and three hours post-resuscitation (2.7 vs. 6.3 mL/kg; p=0.034). In both groups, IL-8 levels were significantly higher after endotoxin administration (103.1 vs. 3854.5 pg/mL; p=0.012 in the colloid group and 125.0 vs. 4419.3 pg/mL; p=0.003 in the crystalloid group). There was no significant difference in IL-8 and VCAM-1 levels between the two groups.

Conclusion. The use of colloids in fluid resuscitation does not decrease the probability of ARDS events compared to crystalloids. Compared to crystalloids, colloids are associated with a lower increase in EVLWI and a lower mean lung injury score, but not with IL-8 or VCAM-1 levels."

"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."

"Praktik Spesialis Keperawatan Medikal Bedah Kekhususan Respirasi di RSUP Perasahabatan Jakarta merupakan aplikasi peran dan fungsi sebagai ners spesialis dengan menerapkan Model Adaptasi Roy dalam memberikan asuhan keperawatan pada pasien dengan gangguan sistem respirasi baik pada pasien kelolaan utama maupun 30 pasien resume. Selain sebagai pemberi asuhan keperawatan peran perawat spesialis respirasi adalah menerapkan tidakan berbasis bukti ilmiah pada area respirasi yaitu dengan memberikan terapi suara berbasis alam dalam mengurangi kecemasan, agitasi, dan stress pada pasien terpasang ventilator mekanik. Peran selanjutnya dari perawat spesialis respirasi adalah melakukan inovasi melalui analisi situasi dan studi literature dalam hal ini adalah penerapan The Respiratory Distress Observation Scale (RDOS) dalam menilai risiko terjadinya distress pernapasan. Hasil praktik menunjukan bahwa teori Model Adapatasi Roy dalam memberikan asuhan keperawatan pada pasien dengan gangguan sistem respirasi dan suara berbasis alam cukup efektif dalam mengurangi kecemasan, agitasi, dan stress pada pasien terpasang ventilator mekanik. Serta RDOS dapat diterapkan pada pasien dengan gangguan respirasi dalam menilai risiko distress pernapasan.

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The Practice of Medical Nursing Specialists Specialized in Respiration in RSUP Perasahabatan Jakarta is the application of roles and functions as specialist nurses by applying Roy's Adaptation Model in providing nursing care to patients with respiratory system disorders in both the main managed patient and 30 resume patients. Aside from being a nursing care provider, the role of respiration specialist nurses is to apply scientific evidence-based nursing actions to the area of ​​respiration by providing nature-based sound terapi to reduce anxiety, agitation, and stress in patients with mechanical ventilators. The next role of respiration specialist nurses is to innovate through situation analysis and literature studies in this case is the application of The Respiratory Distress Observation Scale (RDOS) in assessing the risk of respiratory distress. Practical results show that Roy's adaptation theory in providing nursing care to patients with respiratory and natural-based sound disorders is quite effective in , agitation, and stress in patients with mechanical ventilators. As well as RDOS can be applied to patients with respiratory disorders in assessing the risk of respiratory distress."

"ABSTRAKAnak dengan gangguan pernapasan sering mengalami ketidakefektifan bersihan jalan napas akibat sekret yang menumpuk. Pemberian asuhan keperawatan pada anak dengan gangguan oksigenasi dapat dioptimalkan melalui inhalasi menggunakan cairan salin hipertonik. Penggunaan model konservasi Levine dapat diaplikasikan dalam penerapan asuhan keperawatan yang menerapkan prinsip konservasi energi, konservasi integritas struktur, integritas personal dan integritas sosial. Perlunya berkolaborasi dengan tenaga kesehatan lain dalam pelaksanaan intervensi sebagai upaya memperbaiki kerusakan silia yaitu menerapkan konservasi integritas struktural. Dukungan sarana prasarana seperti alat nebuliser, pengadaan kemasan dan penyimpanan cairan salin hipertonik dapat meningkatkan kompetensi perawat spesialis dalam melakukan praktek pada anak dengan gangguan pemenuhan oksigenasi.

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ABSTRACTChildren who experience respiratory distress often encounter ineffective airway clearance caused by secret accumulation. Nursing care in children with oxygenation disturbance can be optimized through the use of hypertonic saline inhalation. The use of Levine?s conservation model applied in the implementation of nursing care facilitated children?s energy conservation, structural integrity conservation, personal integrity and social integrity. There was a need for collaboration with other health professionals in the implementation of the intervention as an effort to repair the damage of cilia, namely implementing structural integrity conservation. Infrastructure support such as nebuliser, packaging procurement and storage of hypertonic saline may improve the competence of specialist nurses in practice in children with impaired oxygenation fulfillment."

"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."

"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."

"Latar Belakang: Gawat napas merupakan kondisi di saat sistem pernapasan tidak mampu untuk melakukan pertukaran gas secara normal tanpa bantuan. Diperlukan suatu metode atau skala penilaian untuk menilai gawat napas secara lengkap. Pada tahun 2018, Menaldi Rasmin mengembangkan sistem penilaian untuk menilai derajat keparahan keluhan sesak napas yang dinamakan Klasifikasi Klinis Gawat Napas yang terdiri dari tiga variabel pemeriksaan fisis: kesadaran, frekuensi nadi dan saturasi oksigen dari pulse oxymetry. Penelitian ini bertujuan untuk mengetahui tingkat akurasi instrumen penilaian Klasifikasi Klinis Gawat Napas dan kaitannya dalam menilai abnormalitas Analisis Gas Darah (AGD) pada pasien IGD RS Persahabatan.Metode: Penelitian ini merupakan penelitian observasional yang menggunakan desain cross sectional yang dilakukan di IGD RS Persahabatan pada bulan April 2023 – Agustus 2023. Subjek penelitian ini adalah pasien yang menjalani pengobatan di IGD KSM Paru RS Persahabatan serta memenuhi kriteria inklusi dan eksklusi. Pada setiap subjek dilakukan penilaian derajat gawat napas menggunakan Klasifikasi Klinis Gawat Napas dan instrumen penilaian Respiratory Distress Observation Scale (RDOS) sebagai pembanding. Dikumpulkan juga data AGD dan karakteristik tiap subjek.Hasil: Pada penelitian ini didapatkan 189 subjek penelitian. Jenis abnormalitas AGD yang paling banyak ditemukan adalah hipoksemia pada 31 pasien (16.4%). Derajat gawat napas berat memiliki risiko lebih tinggi untuk AGD abnormal dibandingkan gawat napas ringan (OR 26.0 (CI95% 6.3 - 106.7), p=0.005). Penilaian menggunakan Klasifikasi Klinis Gawat Napas memiliki nilai terbaik pada cut-off skor ≥ 5 dengan sensitivitas 53.6 %, spesifitas 95.7% dan Youden Index 0.493, serta nilai AUC sebesar 0.77 dalam menilai abnormalitas AGD. Sedangkan penilaian dengan RDOS memiliki nilai terbaik pada cut-off skor ≥ 4 dengan sensititivitas 75.3%, spesifitas 53.3% dan Youden Index 0.286 serta nilai AUC sebesar 0.67.Kesimpulan: Klasifikasi Klinis Gawat Napas menunjukkan manfat dalam aplikasi klinis sebagai penilaian awal derajat keparahan gawat napas serta dapat digunakan untuk mendeteksi abnormalitas AGD.

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Background: Respiratory distress is a condition when the respiratory system is unable to carry out normal gas exchange without assistance. A method or assessment scale is needed to assess respiratory distress completely. In 2018, Menaldi Rasmin developed a scoring system to assess the severity of respiratory distress called the Clinical Classification of Respiratory Distress which consist from three variable : consciousness, respiratory rate and oxygen saturation from pulse oxymetry. This study aims to determine the level of accuracy of Clinical Classification of Respiratory Distress assessment instrument and its relation in assessing Arterial Blood Gas (ABG) abnormalities in emergency room patients at Persahabatan Hospital.

Methods: This research is an observational study using a cross-sectional design which was conducted in the emergency room at Persahabatan Hospital in April 2023 – August 2023. The subjects of this study were patients at pulmonology emergency room at Persahabatan Hospital and met the inclusion and exclusion criteria. Each subject was assessed for the degree of respiratory distress using the Clinical Classification of Respiratory Distress and Respiratory Distress Observation Scale (RDOS) assessment instrument as a comparison. ABG data and characteristics of each subject were also collected.

Result: In this study, there were 189 research subjects. The most common type of ABG abnormality found was hypoxemia in 31 patients (16.4%). Severe respiratory distress had a higher risk of abnormal ABG than mild respiratory distress (OR 26.0 (CI95% 6.3 - 106.7), p=0.005). Assessment using the Clinical Classification of Respiratory Distress has the best value at a cut-off score ≥ 5 with sensitivity of 53.6%, specificity of 95.7% and Youden Index of 0.493, as well as an AUC value of 0.77 in assessing ABG abnormalities. Meanwhile, assessment with RDOS has the best value at a cut-off score ≥ 4 with a sensitivity of 75.3%, specificity of 53.3% and a Youden Index of 0.286 and an AUC value of 0.67.

Conclusion: Clinical Classification of Respiratory Distress can be useful in clinical practice as an initial assessment for the severity of respiratory distress and can be used to detect ABG abnormalities."

"Latar Belakang: Acute Respiratory Distress Syndrome (ARDS) merupakan salah satu komplikasi progresivitas pneumonia, dengan risiko mortalitas dan kebutuhan ventilasi mekanik yang sangat tinggi. Identifikasi risiko tinggi kejadian ARDS sangat penting untuk meningkatkan kewaspadaan tenaga medis dan upaya pencegahan yang optimal. Tujuan: Mengetahui insidens ARDS pada pasien pneumonia dan mengetahui apakah hipoalbuminemia dapat memprediksi kejadian ARDS dalam 14 hari perawatan. Metode: Studi kohort prospektif pasien pneumonia yang dirawat ruang rawat inap RSPUN dr. Cipto Mangunkusumo dalam periode 1 Agustus-31 Desember 2015. Hipoalbuminemia didefinisikan sebagai kadar albumin admisi < 2,5 g/dL. Kejadian ARDS dinilai berdasarkan pemenuhan kriteria Berlin dalam 14 hari perawatan. Hasil: Subjek pada penelitian ini sebanyak 120 pasien. Insidens kumulatif ARDS sebesar 17,5% (IK95% 10,7%-24,3%). Analisis bivariat menunjukkan hipoalbuminemia dapat memprediksi peningkatan risiko ARDS dalam 14 hari perawatan (RR 3,455; IK 95% 1,658-7,200). Terdapat hubungan bermakna antara sepsis saat admisi dan keseimbangan cairan dengan kejadian ARDS dalam 14 hari perawatan. Analisis multivariat menunjukkan RR hipoalbuminemia setelah penyesuaian adalah 3,274 (IK 95% 1,495-5,528), dengan variabel perancu sepsis saat admisi. Simpulan: Insidens ARDS pasien pneumonia dalam 14 hari perawatan adalah 17,5%. Hipoalbuminemia dapat memprediksi peningkatan risiko kejadian ARDS dalam 14 hari perawatan pasien pneumonia.

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Background: Acute Respiratory Distress Syndrome (ARDS) is one of complication for pneumonia progression, it is associated with higher risk of mortality and increased need for mechanical ventilation. Identification of patients with high risk of developing ARDS is essential to increase physician alertness and ensure optimal prevention.

Purpose: To obtained information about incidence of ARDS in pneumonia diagnosed patients, and if hypoalbuminemia can predict occurrence of ARDS in 14 days after diagnosed pneumonia.

Method: Prospective cohort study in pneumonia diagnosed patients admitted in August until 31 December 2015, with 14 days of observation, all patient is being treated in medical ward unit of Cipto Mangunkusumo Hospital. Hypoalbuminemia is defined as albumin level below 2,5 g/dL and ARDS is defined by Berlin criteria.

Result: The study has enrolled 120 patient. Cumulative incidence of ARDS is 17,5% (IK95% 10,7%-24,3%). Bivariate analysis showed hypoalbuminemia could predict increased risk of ARDS in 14 days after diagnosed pneumonia (RR 3,455; IK 95% 1,658-7,200). There is significant relationship between sepsis at time of admission and mean fluid balance. Multivariate analysis shows adjusted RR 3,274 (IK 95% 1,495-5,528), with sepsis at time of admission as a confounder.

Conclusion: Cumulative incidence of ARDS in pneumonia diagnosed patient after 14 days is 17,5%. Hypoalbuminemia could predict increased risk of ARDS in 14 days of treatment in pneumonia diagnosed patients."

"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."