Pendahuluan: Saat ini COVID-19 masih menunjukkan peningkatan dalam hal prevalensi dan mortalitasnya. COVID-19 mempunyai gejala berupa demam, batuk kering, fatique, dan kemudian berkembang menjadi sesak napas sampai gagal napas dan ARDS. Happy hipoxemia ditemukan pada sebagian pasien yaitu secara subjektif pasien tidak menyatakan adanya sesak, namun didapatkan gangguan oksigenasi. Diperlukan suatu parameter untuk mengevaluasi derajat oksigenasi pada semua pasien COVID-19 yang dapat menjadi prediktor derajat keparahan COVID-19 dan memberikan suatu gambaran untuk rencana tatalaksana lebih lanjut. Objective : Menganalisis hasil pemeriksaan Analisis Gas Darah pada pasien yang dirawat di rumah sakit dan hubungannya dengan derajat keparahan penyakit COVID-19.Metode: Analisis observasional dengan pendekatan cross sectional, single-center, pada 71 pasien terkonfirmasi COVID-19 dilakukan antara bulan April-Juli 2020 pada pasien yang dirawat di Ruang COVID RS Dr. Saiful Anwar Malang, Indonesia. Analisis statistik digunakan untuk menilai hasil analisis gas darah dengan derajat keparahan penyakit. Hasil: Subjek terdiri dari 71 pasien terkonfirmasi COVID-19 terbagi menjadi 2 kelompok, 25 pasien (35,21% ) kelompok ringan sedang dan 46 pasien (64,79%) kelompok berat. Demografis dan karakteristik klinis menunjukkan bahwa usia, riwayat merokok, keluhan sesak dan penggunaan oksigen berhubungan dengan derajat keparahan penyakit (masing masing dengan p<0,05). Analisis gas darah menunjukkan hubungan antara derajat keparahan penyakit dan derajat oksigenasi yang dinilai dari PaO2, SaO2 BGA, PaO2/FiO2 dan original PaO2 (masing masing dengan p<0,05). Kesimpulan: Derajat oksigenasi berhubungan dengan keparahan pasien COVID-19 rawat inap.
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Lung imaging in certain conditions, such as in patients with Acute Respiratory Distress Syndrome (ARDS), poses its challenges. Heterogeneity of lung damage in ARDS can only be detected by CT scan, causing treatment delay and increased mortality. Difficulty to perform standard imaging such as CXR in such patients also contributes to the increasing incidence of VALI (Ventilator-Associated Lung Injury) due to diagnosis delay. EIT (Electrical Impedance Tomography) is a novel imaging method that uses electrical impedance modality. EIT is a bedside, continuous imaging method which can depict both solids and fluids (including air) in body cavities, both statically and dynamically. EIT carries the potency to be the primary lung imaging method for patients in intensive care in the future. Pencitraan paru mempunyai tantangan tersendiri pada beberapa kondisi pasien, misalnya pada sindrom distres pernapasan akut (Acute Respiratory Distress Syndrome/ARDS). Heterogenitas kerusakan paru pada ARDS hanya bisa dideteksi menggunakan CT scan, mengakibatkan keterlambatan penanganan serta meningkatnya mortalitas. Kesulitan melakukan pencitraan standar seperti foto polos toraks juga turut berkontribusi dalam meningkatnya insidens VALI (Ventilator-Associated Lung Injury) karena keterlambatan diagnosis. EIT (Electrical Impedance Tomography) merupakan metode pencitraan baru menggunakan modalitas impedansi listrik. EIT dapat mencitrakan benda padat ataupun fluida (termasuk udara) dalam rongga tubuh dengan baik, baik secara statis maupun dinamis, secara kontinu (bedside). EIT berpotensi menjadi metode utama pencitraan paru pasien-pasien di perawatan intensif.
INTRODUCTION Lactate dehydrogenase (LDH), C-Reactive Protein (CRP), D-dimer and feritin are acute phase proteins which levels may rise in the presence of an inflammatory process of COVID-19. N-Acetylcysteine (NAC) is an antioxidant which has also been widely considered as adjunctive therapy in COVID-19. We aim to analyze the effect of NAC administration in improving oxidative stress and inflammation in COVID-19 through assessment of LDH, CRP, D-dimer, and feritin levels. METHOD A quasi-experimental study with pre-post design. LDH, CRP, D-dimer, and feritin levels were measured in admission and day 8 of administration of 5000 mg/72 hours of NAC. RESULT There is a significant decrease in CRP, LDH, D-dimer and Ferritin levels between admission and day 8 of NAC therapy. CRP levels were reduced from 185.31 ± 181.30 to 97.60 ± 161.86 (p<0.001), LDH levels were reduced from 4.65 ± 4.13 to 1.87 ± 0.96 (p<0.001), D-dimer levels were reduced from 185.31 ± 181.30 to 97.60 ± 161.86 (p<0.001) and Ferritin levels were reduced from 4.65 ± 4.13 to 1.87 ± 0.96 (p<0.001). DISCUSSION There is a significant decrease of LDH, CRP, D-dimer, and feritin levels from day-1 (admission) to day-8 of NAC administration in accordance with existing theories. This implies the ability of NAC to reduce oxidative stress and inflammation in COVID-19 patients. CONCLUSION There was a decrease in CRP, LDH, D-dimer and Ferritin after administration of NAC in COVID-19 patients and a positive correlation between severity and mortality towards acute phase protein in COVID-19 patients.
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