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"Latar Belakang: Pandemi COVID-19 telah menjadi tantangan besar bagi dunia kesehatan. Tenaga kesehatan merupakan populasi yang sangat rentan tertular dikarenakan tingginya intensitas dan frekuensi pajanan SARS-CoV-2. Risiko penularan meningkat apabila tenaga medis melakukan tindakan yang memicu aerosilisasi, salah satunya adalah intubasi endotrakeal karena tingginya viral load pada saluran napas. Sebanyak 3,2% pasien COVID-19 memerlukan tindakan intubasi endotrakeal dan ventilasi mekanis. Intubasi endotrakeal yang efektif pada pasien COVID-19 penting dilakukan untuk menurunkan mortalitas dan risiko penularan. Penelitian ini bertujuan intuk mengetahui faktor-faktor yang memengaruhi efektivitas intubasi endotrakeal pada pasien terkonfirmasi COVID- 19 di RSUP Persahabatan.Metode: Penelitian ini merupakan penelitian observasional yang menggunakan desain potong lintang yang dilakukan di IGD, ICU Rasmin Rasjid dan ICU PINERE RSUP Persahabatan pada bulan Juni 2021 – Juni 2022. Subjek peneltian ini adalah pasien terkonfirmasi COVID-19 yang dilakukan tindakan intubasi endotrakeal yang memenuhi kriteria inklusi dan eksklusi. Tindakan intubasi endotrakeal dinilai dari observasi rekaman CCTV. Selanjutnya karakteristik subjek, karakteristik intubasi endotrakeal dan faktor-faktor yang memengaruhi intubasi endotrakeal dievaluasi.Hasil: Pada penelitian ini didapatkan 59 subjek penelitian. Proporsi intubasi endotrakeal efektif pada pasien COVID-19 sebesar 20,34%. Median lama waktu tindakan intubasi endotrakeal adalah 38 (19-189) detik. Sebanyak 32 (54,24%) tindakan intubasi endotrakeal dilakukan oleh spesialis anestesi dan 27 (45,76%) oleh PPDS Pulmonologi dan Kedokteran Respirasi. Hasil analisis bivariat didapatkan hasil bermakna secara statistik pada variabel penyakit kardiovaskular+DM (OR 0,24 (IK 95% 0,06-0,91), p=0,028) dan variabel operator (OR 0,07 (IK 95% 0,01-0,62), p=0,004). Hasil analisis multivariat menunjukkan hasil bermakna secara statistik hanya pada variabel operator (adjusted OR 0,06 (IK 95% 0,01-0,60), p=0,016).Kesimpulan: Terdapat hubungan penyakit kardiovaskular+DM dan operator terhadap intubasi endotrakeal efektif pada pasien COVID-19 di RSUP Persahabatan.

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Background: The COVID-19 pandemic has become a major challenge for the healthcare system. Healthcare workers are vulnerable population of COVID-19 transmission due to high intensity and frequency of exposure to SARS-CoV-2. The risk of transmission increases in aerosolization procedure such as endotracheal intubation because of the high viral load in the airways. Approximately 3.2% of COVID-19 patients require endotracheal intubation and mechanical ventilation. Effective endotracheal intubation in COVID-19 patients is important parameter to reduce mortality and the risk of transmission to healthcare workers. This study aims to determine the factors that influence the effectiveness of endotracheal intubation in patients with COVID-19 in National Respiratory Center, Persahabatan Hospital.

Methods: This study is an observational study using a cross-sectional design which was carried out in the emergency department, ICU Rasmin Rasjid and ICU PINERE of National Respiratory Center, Persahabatan Hospital in June 2021 – June 2022. The subjects of this study were COVID-19 patients who underwent endotracheal intubation who met the criteria inclusion and exclusion. The endotracheal intubation procedure was assessed from the observation of CCTV recordings. The characteristics of the subject, the characteristics of endotracheal intubation and the factors that influence endotracheal intubation were evaluated.

Results: In this study, there were 59 subjects. The proportion of effective endotracheal intubation in COVID-19 patients was 20.34%. The median length of time for endotracheal intubation was 38 (19-189) seconds. Among the subjects, 32 (54.24%) endotracheal intubation were performed by anesthesiologists and 27 (45.76%) were performed by Pulmonology and Respiratory Medicine residents. The results of the bivariate analysis showed statistically significant results on the cardiovascular disease + DM comorbid (OR 0.24 (95% CI 0.06-0.91), p=0.028) and operator (OR 0.07 (95% CI 0.01-0.62), p=0.04). The results of the multivariate analysis showed statistically significant results only for operator (adjusted OR 0.06 (95% CI 0.01-0.60), p=0.016).

Conclusion: There is relationship of cardiovascular disease + DM comorbid and operator with effective endotracheal intubation in COVID-19 patients at National Respiratory Center, Persahabatan Hospital."

"Latar Belakang: Transbronchial needle aspiration (TBNA) konvensional merupakan salah satu modalitas minimal invasif yang digunakan untuk diagnosis dan staging kanker paru serta tumor mediastinum terutama jika EBUS-TBNA tidak tersedia. Penelitian ini dilakukan untuk mengetahui tingkat kepositifan biopsi TBNA konvensional KGB paratrakeal kanan bawah (KGB 4R) dan subkarina (KGB 7) pada pasien kanker paru dan tumor mediastinum. Metode: Penelitian ini menggunakan desain potong lintang. Pengumpulan data dilakukan dengan cara observasi langsung pada pasien kanker paru atau tumor mediastinum yang menjalani TBNA konvensional pada KGB 4R dan/atau KGB 7 di RSUP Persahabatan Jakarta, Indonesia. Hasil Penelitian: Total 33 pasien menjalani tindakan TBNA konvensional. Hasil TBNA positif sebanyak 20 (60,6%) yang terdiri dari 18 kasus keganasan dan dua kasus infeksi M. Tuberculosis. Pada kasus adenokarsinoma 58,3% pemeriksaan mutasi EGFR menggunakan sediaan sitologi TBNA. Jarum 21 G memberikan hasil TBNA positif lebih banyak dibandingkan jarum 19 G (masing-masing 68,2% dan 45,5%). Kelompok 1-2 set TBNA menunjukkan hasil TBNA positif 55,6% sedangkan kelompok 3-4 set TBNA menunjukkan hasil TBNA positif 66,7%. Kelompok jiggling 10-14 tusukan menunjukkan hasil TBNA positif 70% sedangkan kelompok jiggling 15-20 tusukan menunjukkan hasil TBNA positif 56,5%. Kelenjar getah bening subkarina memberikan hasil TBNA positif lebih banyak dibandingkan KGB paratrakeal kanan bawah (masing-masing 75% dan 47,1%). Ukuran KGB < 30 mm memberikan hasil TBNA positif lebih sedikit dibandingkan ukuran KGB ≥ 30 mm (36,4% berbanding 53,8%). Kesimpulan: Jarum TBNA 21 G, pengambilan spesimen sitologi sebanyak 3-4 set TBNA, jumlah jiggling sebanyak 10-14 tusukan, KGB 7 dan KGB berukuran ≥ 30 mm memberikan hasil TBNA positif lebih banyak.

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Background: Minimally invasive conventional transbronchial needle aspiration (C-TBNA) is an alternative method for diagnosing and staging a lung cancer and mediastinal tumor when EBUS-TBNA is unavailable. This study was to determine the positivity level of C-TBNA biopsies in different techniques (repeated sets and jiggled) at the right lower paratracheal (station 4R) and subcarinal (station 7) lymph nodes in lung cancer and mediastinal tumor cases.

Methods: This cross-sectional study was carried out by direct observation of lung cancer and mediastinal tumor cases examined by using C-TBNA of the station 4R and/or 7 lymph nodes at Persahabatan Hospital Jakarta, Indonesia.

Results: A total of 33 patients underwent C-TBNA. Positive results were 20 (60.6%), of which 18 cases were malignancy and two cases were M. tuberculosis infection. In the case of adenocarcinoma, 58.3% showed EGFR mutations from cytological exam. The 21 G needle yielded more positive TBNA results than the 19 G needle (68.2% and 45.5%, respectively). Repeated 1-2 sets of TBNA showed 55.6% positive results while repeated 3-4 sets of TBNA showed 66.7% positive results. The 10-14 jiggled TBNA showed 70% positive results while the 15-20 jiggled TBNA showed 56,5% positive results. Station 7 lymph node TBNA received more positive TBNA results than station 4R lymph node (75% and 47.1%, respectively). Lymph nodes of size < 30 mm yielded less positive TBNA result than of size ≥ 30 mm (36.4% vs 53.8%).

Conclusion: Specimen collection using 21 G TBNA needle, by means of repeated 3-4 sets or 10-14 jiggled, done at station 7 lymph nodes, and at lymph nodes of size ≥ 30 mm were observed to yield more positive TBNA results."

"Latar Belakang: Penegakkan diagnosis sedini dan setepat mungkin menjadi hal utama dalam penatalaksanaan kanker paru. Beberapa penelitian sebelumnya tentang biopsi transtorakal dengan panduan USG menunjukkan akurasi diagnosis yang cukup baik. USG dinilai sebagai modalitas radiologi yang mudah digunakan secara aman, bedside, real-time, mobile dan bebas pajanan radiasi. Saat ini di RSUP Persahabatan Jakarta belum terdapat penelitian tentang biopsi jarum halus transtorakal dengan panduan USG.Metode Penelitian:  Studi observasional dengan pendekatan potong lintang terhadap subjek dengan tumor paru atau tumor mediastinum yang dilakukan biopsi jarum halus transtorakal dengan panduan ultrasononografi toraks pada bulan April-September 2021. Pengambilan sampel dilakukan secara consecutive sampling. Peneliti melakukan observasi terhadap karakteristik lesi, karakteristik prosedur dan komplikasi. Diagnosis akhir berdasarkan hasil sitologi biopsi jarum halus transtorakal dengan panduan USG.Hasil Penelitian: Dari 46 subjek, rerata usia subjek adalah 52 tahun dan didominasi jenis kelamin laki-laki (69,6%) dan jenis tumor terbanyak adalah tumor paru (80,4%). Proporsi kepositifan sitologi biopsi jarum halus transtorakal dengan panduan USG toraks adalah 78,3%. Karakteristik lesi pada subjek dengan hasil sitologi TTNA positif antara lain memiliki rerata diameter lesi 9,61 ± 2,27 cm, lesi di anterosuperior paru (63,9%), memiliki gambaran ekogenitas hipoekoik heterogen (58,3%) dan memiliki kontak dengan pleura (77,8%). Karakteristik prosedur pada subjek dengan hasil sitologi TTNA positif antara lain dilakukan teknik aspirasi (77,8%), pengambilan TTNA sebanyak < 3 set (58,3%), rerata jumlah gelas objek yang terpakai adalah 15 ± 4 dan median kedalaman insersi adalah 4 (2 – 6) cm. Komplikasi pasca tindakan terjadi pada dua subjek yaitu hemoptisis (4%).Kesimpulan: Biopsi jarum halus transtorakal merupakan metode diagnostik yang invasif minimal dengan proporsi kepositifan yang tinggi (78,3%) dan angka komplikasi yang rendah (4%).

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Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) using second-line drugs is known to have more side effects. Recent studies have shown concern about bedaquiline and delamanid that can cause a prolonged QT interval. This condition is a known risk factor for Torsades de Pointes, a lethal cardiac arrhythmia. This study sought to observe the condition among such patients treated in the study location.

Methods: This study was a prospective cohort study  of MDR-TB patients receiving bedaquilin in the outpatient clinic and inpatient ward of National Respiratory Referral Hospital Persahabatan, Jakarta, Indonesia between February 2020 to February 2021. Patients received 400 mg on week 0-2 (intensive phase) and followed by 200 mg 3 times per week (continuation phase) of bedaquiline. Sampling was carried out by consecutive sampling and data on subjects who met the inclusion criteria were taken from medical records.

Result: From a total of 71 subjects, all of them met the inclusion criteria. Prolonged QT interval was experienced in 18.3% patients. From eleven patients who experienced prolonged QT interval, two patients required hospitalization: one presented with nausea and gastric upset and one patient presented with dyspnea and palpitation. Prolonged QT interval occurred in initial phase and correlated with drug dosing. A mycobacterial culture conversion at month-6 was observed in those receiving multidrug regimens which include bedaquiline, quinolone, and clofazimine. There was a correlation between prolonged QT interval and hypocalemia. Treatment success rate was 46.5% without prolonged QT. Other outcomes included 4.2% died, 26.8% loss-to-follow up, and 4.1% treatment failed.

Conclusion: The use of bedaquiline MDR-TB appeared to be effective and safe across different settings, although the certainty of evidence was assessed as very low. Hypokalemia was correlated with the outcomes of patients receiving bedaquiline, particularly in those experienced prolonged QT interval."

"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."

"Latar belakang : Bronkoskopi merupakan tindakan penting dalam bidang pulmonologi. Bronkoskopi memiliki peran diagnostik dan terapetik pada pasien perawatan intensif yang tidak dapat ditransport ke tempat pemeriksaan pencitraan. Pasien dalam perawatan intensif dapat terintubasi ataupun tidak. Pasien terintubasi dengan ventilasi mekanis dapat mengalami pneumonia akibat virus, bakteri maupun jamur. Retensi sekresi bronkus dapat menyumbat saluran napas dan meningkatkan risiko infeksi. Metode: Penelitian ini bertujuan untuk mengetahui profil tindakan bronkoskopi pada pasien di Instalasi perawatan intensif (IPI) Rumah Sakit rujukan Respirasi Nasional Persahabatan. Desain penelitian ini yaitu deskriptif dan bersidat retrospektif berdasarkan data pada rekam medik pasien. Penelitian ini dilakukan di IPI RS Persahabatan pada bulan November 2023 sampai Februari 2024 dengan subjek penelitian yaitu pasien di IPI yang menjalani tindakan bronkoskopi pada periode 1 Januari 2022 sampai 31 Juli 2023 yang memenuhi kriteria inklusi. Besar sanpel pada penelitian ini yaitu 113 pasien. Analisis dilakukan pada 70 pasien yang menjalani tindakan bronkoskopi di IPI. Data yang diiperoleh diolah dan dianalisis univariat dengan perangkat lunak SPSS. Hasil : Median umur pasien yang menjalani tindakan bronkoskopi didapatkan 51,5 tahun, jenis kelamin laki-laki dominan (61,95%), dengan perangkat oksigenasi sebelum tindakan bronkoskopi yaitu ventilasi mekanis (90%). Pneumonia merupakan diagnosis penyakit paru terbanyak (50%). Komorbid gangguan sistem kardiovaskular terjadi pada 47,14% pasien. Indikasi tindakan bronkoskopi terbanyak yaitu retensi sputum dan atelektasis (31,43% dan 30%). Modalitas tindakan berupa bronchial toilet pada 98,57% pasien. Analgetik digunakan pada 98,52% pasien. Kombinasi analgetik, sedasi, pelumpuh otot dan ketamin serta kombinasi analgetik dan sedasi paling banyak digunakan. Parameter tanda vital paling banyak ditemukan berupa peningkatan tekanan darah dan nadi sebelum dan sesudah tindakan bronkoskopi. Temuan bronkoskopi berupa stenosis kompresi, mukosa hiperemis dan sekret mukopurulen paling banyak ditemukan. Perbaikan gambaran foto toraks setelah tindakan bronkoskopi pada 35,71% pasien. Belum tercantum dengan jelas data komplikasi dua jam pasca tindakan pada pasien di IPI, namun dan tidak didapatkan perburukan dari parameter tanda vital. Median lama perawatan di IPI pada pasien yang menjalani tindakan bronkoskopi yaitu 12 hari. Angka kesintasan pasien yang menjalani tindakan bronkoskopi di IPI yaitu 52,85%.

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Background : Bronchoscopy is an important procedure in the filed of pulmonology. Bronchoscopy has diagnostic and therapeutic role for intensive care patients who cannot be transported to imaging centre. Patients in intensive care may be intubated or not. Intubated patients with mechanical ventilation can experience pneumonia caused by vruses, bacteria or fungi. Retention of bronchial secretions can obstruct the airways and increase the risk of infection. This study aims to determine the profile of bronchoscopy procedures of patient at intensive care installation at hte Persahabatan National Respiratory Center. Method : The design of thins research is descriptive and retrospektive based on data in the patient’s medical record. This research was conducted at intensive care installation Persahabatan Hospital from November 2023 to February 2024. Subject if this study are patients who underwent bronchoscopy procedures from January 1st 2023 until July 31st 2024 whi met the inclusion criteria. The sample size in this study was 113 patients. Analysis was carried out on 70 patients who underwent bronchoscopy at IPI. The data obtained were processed and analyzed univariately using SPSS software. Result : The median age of patients undergo bronchoscopy was 51.5 years, male gender was dominant (61.95%), with oxygenation devices before bronchoscopy, namely mechanical ventilation (90%). Pneumonia is the most common lung disease diagnosis (50%). Comorbid cardiovascular system disorders occurred in 47,14% of patients. The most frequent indication for bronchoscopy were sputum retention and atelectasis (31,43% and 30%). The modality of bronchoscopy was bronchial toilet in 98.52% of patients. Analgesics were used in 98.52% of patients. Combination of analgetics, sedatiopm, muscle relaxant and ketamine as well as combiantion of analgetics and sedation are most widely used. The most common vital sign parameters found were an increase in blood pressure and pulse before and after bronchoscopy. Bronchoscopy findings in the form of compression stenosis, hyperemic mucosa and mucopurulent discharge were most commonly found in patients undergoing bronchoscopy at IPI. Chest radiograph improvement after bronchoscopy in 35.71% of patients. There were no clear data on two-hours complications after the procedure, however there was no deterioration in vital sign parameters. The median length of stay at IPI for patients undergoing bronchoscopy is 12 days. The survival rate for patients who undergo bronchoscopy at IPI is 52.85%."