Correlation between serum surfactant protein-D level with respiratory compliance and acute respiratory distress syndrome in critically ill COVID-19 Patients: A retrospective observational study.

Background: Acute respiratory distress syndrome (ARDS) is one of the manifestations of severe coronavirus disease 2019 (COVID-19) with low respiratory compliance and poor oxygenation as main characteristics and mortality rate of 50%-94%. Surfactants, including surfactant protein D (SP-D), have a role in maintaining respiratory compliance. This study aimed to analyze the relationship between serum SP-D levels with respiratory compliance and ARDS in patients with critically ill COVID-19 pneumonia. Methods: This study was a cross-sectional study. Subjects were adult reverse transcription-polymerase chain reaction-confirmed COVID-19 patients who had ARDS treated with invasive mechanical ventilation. All data were obtained from medical records. Statistical analysis was done using Spearman test, Mann-Whitney test, and receiver operating characteristic curve. Results: Serum level of SP-D was significantly correlated with static respiratory compliance (P = 0.009; correlation coefficient [rs] = 0.467). Serum SP-D levels correlated with ARDS severity (P < 0.001). SP-D levels had a very strong diagnostic value for ARDS severity, with an optimal cutoff value of 44.24 ng/mL (sensitivity 92.3%; specificity 94.1%). ARDS severity also correlated significantly with respiratory compliance (P = 0.005; correlation coefficient 0.496). Conclusion: Higher serum SP-D levels were associated with lower respiratory compliance, ARDS severity, and may be utilized diagnostically to identify patients with severe ARDS.

Comparison of Effectiveness between Wycope Video Laryngoscope, C-MAC Video Laryngoscope, and Direct Laryngoscope in Intubation of Elective Surgery Patients.

OBJECTIVE: Airway management has undergone a dramatic transformation since the arrival of video laryngoscope (VL). VL has higher intubation success rate on first try and lower complications in comparison to direct laryngoscope (DL). The use of VL is recommended in intubating COVID-19 patients to speed up intubation time and reduce failure rate. A team from Airlangga University developed Wycope Video Laryngoscope (Wycope VL), a VL with Wi-Fi connection to smartphones for an easier VL with low cost. This study aimed to compare the effectiveness of Wycope VL, C-MAC Video Laryngoscope (C-MAC VL), and DL. MATERIALS AND METHODS: This study was an analytic observational study with a cross sectional design, involving 63 patients who were divided into 3 groups based on the type of laryngoscope, namely Wycope VL, C-MAC VL, and DL. Intubation is carried out by 4th year anaesthesiology resident. Research subjects were patients who will undergo elective surgery at Dr. Soetomo General Hospital under general anaesthesia using orotracheal tube. Inclusion age of 19-64 years, PS ASA 1-2, no anatomical abnormalities of the airway, did not have difficult airway, and was willing to participate in the study. RESULTS: All patients were successfully intubated without complications. C-MAC VL (5.33±1.42 seconds) and Wycope VL (5.95±0.74 seconds) was significantly faster in seeing vocal folds and glottis compared to DL (7.14±0.72 seconds) with P=0.000. DL was significantly faster in average time of intubation (15.52±5.90 seconds) compared to C-MAC VL (16.95±1.11 seconds) and Wycope VL (20.29±2.81 seconds) with P=0.000. CONCLUSION: DL was faster compared to VL in speed of intubation while C-MAC VL and Wycope VL was faster in viewing the vocal folds and glottis compared to DL.

The relationship between neutrophil-lymphocyte ratio and quick sequential organ failure assessment on Covid-19 patients' mortality

Introduction: Coronavirus disease 19 (Covid-19) transmission could lead to varied symptoms, from mild, moderate, severe, and critical symptoms that require intensive care. The transmission can be predicted by the neutrophillymphocyte ratio (NLR) and the quick Sequential Organ Failure Assessment (qSOFA) value when the patient is admitted to the emergency department (ED) to anticipate the high mortality rate. Methods: This study was an observational analytic study with a retrospective cohort study to analyze the medical records of Covid-19 patients from July to December 2020 at the . North Maluku Referral Hospital. NLR and qSOFA were calculated on admission to the ED. Results: The total of Covid-19 patients was 268 (245 were alive and 23 died). There was an increase in NLR in patients who died with a cutoff value of 12.42, a sensitivity of 82.6%, and a specificity of 89% (area under the receiver operating characteristic [ROC] curve [AUC] 0.894;p<0.001). There was also an increase in qSOFA with a cut-off of 2, sensitivity 73.9%, and specificity 85.3% (AUC 0.861;p<0.001). The mortality of patients with qSOFA ³2 was 32.1%. Conclusion: There was a significant relation between NLR and qSOFA with mortality that happened in Covid-19 patients.