Tesis

Efek Posisi Prone Pada Pernapasan Pasien Covid-19 yang Mengalami ARDS Berat: Serial Kasus = Prone Position Effect for Respiratory Function in ARDS Patients due to COVID-19 : Serial Case Report.

Latar Belakang: World Health Organization (WHO) menetapkan status pandemi COVID-19 secara global pada 11 Maret 2020. Covid-19 terutama mempengaruhi sistem pernapasan menyebabkan pneumonia dan dapat secara cepat masuk ke dalam kondisi acute respiratory distress syndrome (ARDS). Kurangnya pengetahuan mengenai Covid-19 dengan ARDS membuat para petugas medis harus terus mencari tatalaksana yang paling tepat, termasuk terapi non farmakologis.,salah satunya adalah posisi prone. Laporan kasus ini akan membahas mengenai efek posisi prone pada pernapasan pasien Covid-19 yang mengalami ARDS berat. Tujuan: Laporan kasus ini ditujukan untuk mengetahui efek klinis dan efek samping terkait posisi prone pada pasien Covid-19 yang mengalami ARDS berat. Metode: Penelitian ini termasuk jenis penelitian deskiptif retrospektif dengan menggunakan data sekunder yang tercatat di rekam medis rawat inap pasien dengan kasus COVID-19 yang dilakukan posisi Prone selama perawatan di ICU RSUPN Cipto Mangunkusumo. Penelitian ini disajikan dengan desain studi laporan kasus. Laporan Kasus : Tiga pasien dirawat di ICU RSUPN Cipto Mangunkusumo di diagnosis Covid-19 dengan ARDS dan memiliki kondisi awal dan komorbid yang bervariasi. Pada ketiga pasien dilakukan posisi prone selama perawatan. Dari ketiga pasien didapatkan peningkatan PaO2, rasio PaO2/FiO2, saturasi oksigen perifer sejak posisi prone dilakukan hingga beberapa saat setelahnya, tetapi juga penurunan hemodinamik. Luaran di akhir perawatan cukup dipengaruhi kondisi awal dan komorbid Simpulan : Posisi prone memiliki efek perbaikan pada system pernapasan tetapi dengan efek samping pada hemodinamik dan luaran sangat dipengaruhi kondisi awal dan komorbid. Sebaiknya dilakukan pada 48 jam awal gejala ARDS dan dihindari pada komorbid kardiovaskular.
Kata Kunci : acute respiratory distress syndrome, Covid, prone


Background: On March 11 th 2020, World Health Organization (WHO) stated that Covid-19 was a global pandemic. This disease mainly affects the respiratory system that will lead to pneumonia, and quickly becoming into acute respiratory distress syndrome (ARDS. The less knowledge of Covid-19 with ARDS encourages medical workers to find the appropriate management, including non pharmacological therapy, one of it is prone position. This serial case report, will review about the effect of prone position for respiratory function in ARDS patients due to COVID19. Goals: The purpose of this study is to find out the clinical and side effects of prone position on Covid-19 with ARDS patient Method : This study is a retrospective descriptive study that using the medical record of Covid-19 patient whereas prone position have been performed during treatment in RSUPN Cipto Mangunkusumo. This study is presented with design of serial case report. Case Report : Three patients in the ICU of RSUPN Cipto Mangunkusumo with the diagnosis of Covid-19 with ARDS, all have variative condition and comorbids. Prone position have been performed during treatment. From the three patients, there are increase of PaO2, PaO2/FiO2 ratio, peripheral oxygen saturation since prone position was performed and sometime after, but also decreasing in the hemodynamic condition. The outcome at the end of the treatment is influenced by the early condition and comorbid Conclusion : Prone position have good effect on respiratory system, but also also side effect on hemodynamic, and the outcome is influenced by the early condition and comorbid. It is better to be performed at the first 48 hours of the ARDS symptoms and avoided in the patient with cardiovascular comorbid.
Keyword : acute respiratory distress syndrome, Covid, prone