No abstract

Coronary artery bypass graft (CABG) is performed on patients with blocked coronary arteries by creating a shortcut to resolve and improve blood flow to the heart muscle. The CABG procedure can be performed using a cardiopulmonary bypass (CPB) or an off-pump artery bypass graft technique. One complication in heart surgery is acute kidney injury (AKI) incidence. The risk factors in the incidence of AKI include CPB, complications from surgery (e.g., bleeding and blood transfusions), type of surgery, preoperative high-osmolarity state, preoperative serum creatinine level, age >60 years, the presence of comorbid conditions (e.g., hypertension, diabetes, and dyslipidemia), impaired left ventricular function, hemodynamic disturbances, hypoperfusion, use of vasopressor drugs/inotropes, and preoperative hypoalbuminemia. We report an observation to six of our recent patients underwent CABG aged 36–69 years old. Five patients with coronary arterial diseases (CAD) underwent CABG, and one patient with CAD and mitral regurgitation underwent CABG surgery and mitral valve replacement. All patients had a preoperative albumin level of >3.5 g/dL. Two patients developed AKI <24 h postsurgery and three followed by the next day. Serum creatinine monitoring was carried out daily for 7 days, where two patients showed improvement in serum creatinine, and other two had their creatinine returned to normal. This case series found that AKI incidence after CABG was relatively high despite an excellent clinical outcome. Further research is needed with a larger number of cases to find the risk factors for AKI for perioperative prevention.

Noninvasive ventilation (NIV) is one of the alternative therapies for patients with respiratory failure or acute respiratory distress syndrome to avoid endotracheal intubation and its adverse effects. COVID-19 is a disease attacking respiratory system, inducing hypoxic-type respiratory failure. This case report describes that NIV application is somewhat useful in a number of patients with COVID-19 pneumonia suffering from respiratory failure. Nevertheless, in some cases, endotracheal intubation was done. Meticulous observation on deteriorating clinical and laboratory signs is required to make an immediate decision to switch into invasive ventilator to avoid further worsening.

Introduction: The incidence of postoperative CABG AKI in Indonesia, one of which is in the city of Surabaya, is known to reach 69.8%. For this reason, this study was prepared with the aim of analyzing the risk factors of Acute Kidney Injury Incidence following coronary artery bypass graft with cardiopulmonary bypass. Method: The study conducted a prospective analytic study on CABG patients with the CPB technique without a history of previous kidney disease at a hospital in Indonesia in the period 2020. Results: Through the results of the study, it was found that 14 people were diagnosed as AKI after surgery, of which 11 were men. On the other hand, it is also known that AKI patients also experience a longer duration of CPB and also lower plasma osmolarity Conclusion: Of all the factors it is known that eGFR is an independent risk factor for AKI.

Patients with severe symptoms of COVID-19 have an ARDS. HFNC is one of the therapies to treat ARDS in COVID-19. The aim of this study is to analyse the relationship between increased D-Dimer, decreased P/F Ratio and ROX Index with failure of HFNC therapy. This study was an observational, retrospective analytic study with total sampling technique. Ethical clearance was issued by the Ethics Committee of RSUD Dr. Soetomo Surabaya. The study was conducted in the COVID-19 isolation room from June until December 2020. The inclusion criteria were confirmed COVID-19 patients, aged 17-64 years with ARDS symptoms and requiring HFNC. D-dimer, P/F Ratio and ROX Index were observed on day 0 and day 3. The patient was followed while in COVID-19 Isolation Room-1 Dr Soetomo Hospital until discharged from isolation room or need a mechanical ventilation. A total of 87 research subjects were included in this study, and 72 research subjects were further assessed on the 3rd day. The decrease in ROX Index was associated with the incidence of HFNC failure (H-0 p=0.020 and H-3 p< 0.001). The relative risk of HFNC failure in the ROX Index < 3.85 group on day 0 was 2.4 times and on day 3 was 5.1 times. The increase in D-Dimer was associated with the incidence of HFNC failure (H-0 p=0.023 and H-3 p< 0.001). The relative risk of HFNC failure in the group with D-Dimer > 1,360 mcg/l on day 0 was 2.1 times, while in the group with D-Dimer > 2,135 mcg/l on day 3 was 6.2 times. The decrease in the PF ratio was associated with the incidence of HFNC failure (H-0 p=0.011 and H-3 p< 0.001). The relative risk of HFNC failure in the group with PF ratio < 119 mmHg on day 0 was 2.3 times, while in the group with PF ratio < 110.5 mmHg on day 3 it was 9.0 times. There was a significant and strong relationship between increased D-Dimer levels, decreased PF ratio, and decreased ROX Index with the incidence of HFNC failure in the COVID-19 Isolation Room of RSUD Dr Soetomo.