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

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

"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. Padastudi 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 didiagnosissebagai ARDS. Hasil yang didapatkan kemudian dianalisis menggunakan Kaplan-Meier dan analisis multivariatCox regresi. Hasil: studi ini mendapatkan 101 pasien ARDS dalam periode 10 bulan. Kesintasan keseluruhanselama 28 hari adalah 47.5% dan nilai median adalah 10 hari (95% CI 2.47 ? 17.52). Kesintasan pada pasienARDS cenderung menurun signifikan pada minggu pertama setelah didiagnosis ARDS. Hal itu menunjukkanmortalitas 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: kesintasanjangka pendek di negara berkembang seperti Indonesia masih rendah dan manajemen yang optimal pada awaldari 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 andAugust 2016. The primary end point of the study was 28-day short-term survival rate using the initial date of ARDSdiagnosis as the index time. Overall survival rate was analyzed using Kaplan-Meier test and multivariate Coxregression analysis. Results: there were 101 ARDS subjects during 10 months of study. The overall rate of 28-daysurvival was 47.5% and the median time of survival was 10 days (95% CI 2.47?17.52). The survival rate in ARDSpatients was reduced significantly at the first week after the diagnosis of ARDS was made, which indicated that thehighest 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: theshort-term survival rate of ARDS in developing countries including Indonesia is still low and early managementwith optimal treatment provided within the first week may improve the survival rate."

"ABSTRAKLatar 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."

"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: 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.

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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."

"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

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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."

"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. "

"Pada era pandemi COVID-19, perawatan intensif menjadi krusial bagi pasien dengan sindrom gangguan pernapasan akut (ARDS) yang memerlukan alat bantu napas. Setelah perawatan intensif, penting untuk mengevaluasi kualitas hidup penyintas COVID-19 untuk mengetahui dampak jangka panjang terhadap kesehatan fisik dan mental. Penelitian ini bertujuan untuk menilai kualitas hidup dan karakteristik yang memengaruhinya pada penyintas COVID-19 dengan riwayat ARDS pasca penggunaan alat bantu napas, baik invasif dan non-invasif, di ruang perawatan intensif. Penelitian ini menggunakan pendekatan cross-sectional dan dilaksanakan secara multicenter dengan total 56 responden yang memenuhi kriteria inklusi dari tiga rumah sakit rujukan COVID-19 nasional yang masuk dalam jejaring Academic Health System (AHS) Universitas Indonesia. Instrumen yang digunakan adalah The St. George Respiratory Questionnaire (SGRQ). Pada hasil penelitian ini, ditemukan Tingkat kualitas hidup yang rendah berkaitan dengan sistem pernapasan pada domain Tanda dan Gejala serta Aktivitas. Akan tetapi, domain Dampak mempunyai skor kualitas hidup yang baik. Total skor kualitas hidup pada kelompok invasif tergolong rendah yaitu 12 (0-64,9), dan non-invasif (NIV, HFNC dan NRM) yaitu 14 (0,7-57,8). Selain itu, terdapat hubungan kualitas hidup pada kelompok yang menggunakan alat bantu napas non-invasif terhadap usia, pekerjaan, rentang waktu survivor, dan APACHE II.

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In the era of the COVID-19 pandemic, intensive care has become crucial for patients with Acute Respiratory Distress Syndrome (ARDS) who require breathing assistance. After intensive treatment, it is important to evaluate the quality of life of COVID-19 survivors to determine the long-term impact on physical and mental health. This study aims to assess the quality of life and the characteristics that influence it in COVID-19 survivors with ARDS after using ventilatory support, both invasive and non-invasive, in the Intensive Care Unit (ICU). This research used a cross-sectional approach and was carried out in a multicenter manner with a total of 56 respondents who met the inclusion criteria from three national COVID-19 referral hospitals within the University of Indonesia's Academic Health System (AHS) network. The instrument used was The St. George Respiratory Questionnaire (SGRQ). In the results of this study, it was found that a low quality of life was related to the respiratory system in the Signs and Symptoms and Activity domains. However, the Impact domain has a good quality of life score. The total quality of life score in the invasive group was low, namely 12 (0-64.9), and non-invasive (NIV, HFNC and NRM) namely 14 (0.7-57.8). Apart from that, there was a relationship between the quality of life in the group using non-invasive ventilatory support on age, occupation, period of survivors, and APACHE II score."

"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."

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

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