Buku Tatalaksana COVID-19 5 OP Edisi 4 Jan 2022

PEDOMAN TATALAKSANA
COVID-19
Edisi 4
PEDOMAN TATALAKSANA
COVID-19
Edisi 4
Dilarang memperbanyak, mencetak dan menerbitkan sebagian atau seluruh

isi buku ini dengan cara dan dalam bentuk apapun tanpa seijin penulis dan
penerbit.
Perhimpunan Dokter Paru Indonesia (PDPI)

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI)
Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (PAPDI)
Perhimpunan Dokter Anestesiologi dan Terapi Intensif Indonesia
(PERDATIN)
Ikatan Dokter Anak Indonesia (IDAI)
Jakarta, Januari 2022

Coronavirus
disease 2019
Pedoman Tatalaksana COVID-19

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
severe acute respiratory syndrome
coronavirus
Middle East Respiratory Syndrome
seafood live market
World
Health Organization
outbreak
single-stranded

Alpha Beta Delta
in silico docking studies

receptor binding domain

in vitro University of
Hong Kong
spike
sequence spike.
host World Health Organization

:
probable
Rapid Diagnostic
Test

Probable
Probable
Nucleic
Acid Amplification Test

probable
Omicron
probable Omicron
Probable
S-Gene Target Failure

Single Nucleotide Polymorphism
Polymerase Chain Reaction
Omicron
Omicron
Omicron
probable
probable
S-gene
target failure Single
Nucleotide Polymorphism Polymerase
Chain Reaction
Omicron
European Centre for Disease Prevention and

Control,
probable
S-gene target
failure Single Nucleotide Polymorphism
Polymerase Chain Reaction
probable

fatigue
immunocompromised fatigue

grunting
Acute Respiratory Distress Syndrome

follow-up
follow-up
follow-up
Cycle Threshold (CT) value
cutt off
imunocompromised
follow-up

Spike
S Gene Target Failure
S Gene Dropout,

hand sanitizer
goggle .
hand sanitizer

ACE-
inhibitor Angiotensin Reseptor Blocker
non acidic

non acidic

o
loading dose
Isolasi Kasus COVID 19 asimtomatis dan gejala ringan
telemedicine

telemedicine

o
- loading dose

Intensive Care Unit
High Care Unit
o
o
o
o
o
o

pulse oximetry
o
high flow nasal cannula
non-invasive mechanical ventilation
o
awake prone position
High Flow Nasal Cannula

flow
respirator
flow
o
o
o Work of breathing
Awake Prone Position
De-eskalasi
flow

flow
respirator
Trial
PEEP
Work of
breathing

Awake Prone Position
respirator
plateau pressure driving

pressure
Higher
PEEP
prone
plateau
pressure
prone

Airway Pressure Release Ventilation
Extra Corporeal Membrane Oxygenation (
prone
abdominal compartment
syndrome
Clinical Frailty Scale

-
loading dose

prodrug
hydroxycytidine
RNA polimerase
viral load
viral load

-
-

CPY3A clearance

Neratinib
Venetoclax
Amiodarone, bepridil,
dronedarone, encainide,
flecanide, propafenone,
quinidine
Astemizole, terfenadine
Lurasidone
Clozapine, pimozide
Quetiapine
Dihydroergotamine,
ergonovine, ergotamine,
methylergonovine
Lipid-modifying agents
- HMG Co-A Reductase
Inhibitors
- Microsomal
triglyceride transfer
protein (MTTP)
inhibitor
Avanafil
PDE5 inhibitors Sildenafil
Vardenafil
Clorazepate, diazepam,
estazolam, flurazepam, oral
midazolam and triazolam

single dose

overload
starches
responsiveness
vasopressor
first-line vasopressor

Direct acting oral anticoagulant
heparin-induced thrombocytopenia
intermediate

prothrombin time
fibrin degradation
product
Overt
Non-overt
creatinine clearance
international normalized ratio

Skor total: 30,5; interpretasi: < 7 risiko terjadinya perdarahan rendah,
7 peningkatan risiko terjadinya perdarahan, ICU, Intensive care unit;
CCU: Critical Care Unit.

Pasien terinfeksi COVID-19
D-dimer*
Pemeriksaan
Waktu protrombin/PT
Jumlah trombosit
laboratorium
Fibrinogen** sederhana
D-dimer meningkat secara nyata*** 1. D-dimer tidak meningkat secara nyata***

PT memanjang 2. PT memanjang
Hitung trombosit <100 x 109/L 3. Hitung trombosit <100 x 109/L
Fibrinogen < 2,0 g/L 4. Fibrinogen <2,0 g/ L
Rawat inap (meskipun Jika rawat inap karena Jika rawat inap karena
tidak ada indikasi lain) indikasi klinis lain. indikasi klinis lain.
monitor 1-2 kali sehari Monitor setiap hari Monitor setiap hari
Pada semua
Mulai dosis
Memburuk profilaksis LMWH
1. Produk darah sesuai protokol (Iihat “Catatan”)

2. Pertimbangkan terapi eksperimental
Catatan:
Pada pasien tanpa gejala perdarahan, pertahankan
Hitung trombosit di atas 25.000/mm3
Pada pasien dengan gejala perdarahan, pertahankan

Hitung trombosit di atas 25.000/mm3
Fibrinogen di atas 1,5 g/L
Rasio protrombin <1,5 (tidak sama dengan INR)

Unfractionated Heparin
post-
-
probable
heparin-
induced thrombocytopenia
jaundice threatened
abortion
Antithrombotic Therapy and Prevention of

Thrombosis 9th Ed: ACCP Guidelines
(a)
(b)
(a)
(b)
acute coronary
syndrome
(a)
(b)
low molecular weight

heparin

immune mediated heparin-induced
thrombocytopenia
Stroke
(a) intermediate low-intensity

heparin infusion
(b)
direct oral
anticoagulant
Guidelines
American Society of Hematology
American Society of Hematology

heparin-induced thrombocytopenia,
pneumatic
compression devices

bundle
Ventilator Associated Pneumonia
Hospital Acquired Pneumonia

Food and Drug Administration
Emergency Use Authorisation/EUA
Food and Drug Administration

Janus Kinase Inhibitor
strong organic anion transporter 3

inhibitor

Mesenchymal Stem Cell
expanded access programs,

emergency investigational new drug application.
pilot study

Intravenous Immunoglobulin
peer-reviewed
A-a gradient
A-
a gradient

Fluxamine
Fluoxamine selective serotonin re-uptake
inhibitor
mucuous plug

herd immunity
Platform-platform

frailty
Interstitial
Lung Disease (ILD),
whole blood)

syncope

booster
booster,
booster
booster
booster

distress
Mesenchymal Stem
Cell (MSCs)/
Intravenous
Immunoglobuln
(IVIG)
Pasien suspek dan probable COVID-

19 kategori sedang/berat dapat
ditatalaksana seperti pasien COVID-
19 sampai terbukti bukan
*Sesuai indikasi yaitu

memiliki pasien dengan
risiko perburukan atau
kematian dan ketersediaan
obat di fasyankes masing-
masing
** Remdesivir diberikan
hanya pada kasus derajat
sedang-berat/krtis

follow up
follow up
follow up
follow up

Sebagai contoh:
follow up

co-insiden

viral load
viral
load
viral load
post-
acute sequalae post-acute
long
dyspnea,

support group
post-COVID-19 inflammatory lung disease

Long COVID-19

Ventilatory setting

o
prone
staircase
rescue

extracorporeal membrane
oxygenation
P High
P Low
P High inspiratory
recruitment
plateau pressure
P Low end-expiratory
derecruitment

T High inspiratory
recruitment
T Low end-expiratory
derecruitment
peak ekspiratory
flow
T High
P High
T High
Weaning P
High T High
P High T High
continuous positive airway pressure
(CPAP)

High mean Recruitment

pressure
venous
return
cardiac
output
transpulmonary
Venous return pressure
venous
return
Recruitment
work of breathing

suctioning
heat moisture exchanger
analgosedation

capillary refill time
overload
crackles
volume
passive leg rising fluid challenges
pulse pressure
first-line

Glucocorticoid-associated diabetes
glucocorticoid-associated diabetes

sick day management
continuous renal
replacement therapy
variable rate intravenous insulin

infusion
Neutral Protamine Hagedorn
(long acting

social physical distancing
The Infectious Disease Society of America
immunosenescence
deep vein trombosis

deconditioning
flare up
cytokine storm

peritoneal dialysis
probable
fixed dialysis
care system

single use
exit site
automated
peritoneal dialysis continuous renal
replacement therapy prolonged intermittent renal
replacement
Chronic Kidney
Disease
airborne
exist site

Great
imitator Great imitator
angiotensin converting enzyme 2 (ACE-2).

Venous Thrombotic Events/
activated Partial
Thromboplastin Time sepsis induced
coagulopathy Disseminated Intravascular
Coagulation The International Society
on Thrombosis and Haemostasis
prothrombin time
Severe Acute Respiratory Syndrome Coronavirus

Coronavirus Disease 2019
extracorporeal membrane oxygenation

intensive care unit
angiotensin
convertase enzyme-2
ribonucleic acid

low voltage

Ace-inhibitor
non-severe acute respiratory syndrome

cytokine storm cytokine
storm
anti-
failure

bedside point of
care transthoracic echocardiography

Telemedicine
penghambat
angiotensin converting enzym (ACE inhibitor) angiotensin
receptor blockers (ARB
acute kidney injury

European Society of Cardiology
all-cause death

probable
video call

probable
multisystem
inflammatory syndrome
fatigue
wheezing

profuse
acute respiratory distress syndrome
pediatric acute respiratory distress syndrome
Multisystem
inflammatory
syndrome

probable

probable
leaflet
hand
sanitizer
physical distancing

goggle
hand
sanitizer

evidence
Probable/

maintenance
infection control
evidence

infection control
evidence

infection control
evidence

ratio
Oxygen Saturation
Index
Oxygenation Index
Pediatric Acute Lung Injury Conference Consensus
work of breathing

Continuous Positive Airway Pressure Bilevel non-
invasive ventilation
index
Interface
leak
non-vented full-face
double-limb single-limb

leak

checklist
operator airway
airway
patent

suction
video laryngoscope
rapid sequence intubation
filter face mask bag
video laryngoscope disposable

blade
cuff
closed loop
communication
closed
suction

venous thrombotic events
central venous line
KD-like

High flow
atau
Radiologi:
jika D Dimer >5
jika O2 >5L NK, HFNC, NRM,
intubasi
atau
Terapi Antikoagulan
Dosis LMWH sesuai usia:
Obesitas: >120 kg atau BMI>30
Pasien dengan CrCl <30:

droplet
aerosol generated
aerosol
generated
probable

cots

Remdesivir,
Favipiravir
(Avigan),
molnupiravir
Interferon
Tocilizumab
N-acetylcysteine

cots

Probable
Possibe

Unlikely

Probable

Possibe
Unlikely

Probable
Possibe
Unlikely

Possibe

Probable

special care
high care intermediate care intensive
care
possibel atau unlikely

Probable
Ada fasilitas
swab RT-PCR
Ada
fasilitas
swab
ulang
CT value
probable

CT-value
follow up
aerosol
generated

aerosol generated
Post-acute COVID-19 syndrome/Long COVID-19
ongoing
post-COVID-19 syndrome
ground-glass

brain fog
follow up

Viral fecal shedding

Long COVID-19

Long COVID-19
Long COVID-19

Long COVID-19

emergency use authorization

extracorporeal
membrane oxygenation

extracorporeal membrane oxygenation

drug-induced liver injury

pressor response
Non-steroid anti inflammatory drug

buprenorphine, hydromorphone, oxycodone dan tramadol
kodein,
methadone, morfin, fentanyl, dan remifentanil.

OBAT MEKANISME DOSIS EFEK SAMPING PERTIMBANGAN
KERJA PERAWATAN
Fentanyl Reseptor mu- Dosis intermiten: Kekakuan dinding Efek kerja dapat
opioid agonis 0,35-0,5 mcg/kg IV, dada dengan infus memanjang dan
setiap 0,5-1 jam cepat kadang dapat diprediksi
Infus: 0,7-1,0 Bradipneu Pengawasan di ruang
mcg/kg/jam IV intensif
Morfin Reseptor mu- Dosis intermiten: Hipotensi Akumulasi dapat
opioid agonis 0,2-0,6 mg IV, setiap Bradikardi menyebabkan efek
1-2 jam sedasi atau
Infus: 0,5-3 mg/jam neurotoksisitas
Oxycodone Reseptor mu- Dosis oral : 5-20 mg Hipotensi Konsentrasi serum
opioid agonis setiap 4-6 jam meningkat pada pasien
dg CrCl 60 mL/menit
Interaksi obat dengan
inhibitor CYP3A4
Tidak boleh dijadikan
puyer
Gabapentin Modulasi saluran Dosis oral: 900- Edema perifer Dosis harus dikurangi
kalsium 3600mg/hari dibagi berdasarkan CrCl
TID-QID
Karbamazepin Penghambat 200-1200mg/hari Hiponatremia Pengurangan dosis
saluran natrium dibagi BID-TID tergantung dosis 25% pada CrCl <10
Sindroma Stevens- mL/menit
Johnson/Nekrosis Pengurangan dosis
Epidermal Toksik pada gangguan hati
Agranulositosis
Pregabalin Modulasi saluran Dosis intermiten: Edema perifer Dosis harus dikurangi
kalsium 150-600 mg/hari berdasarkan CrCl
dibagi TID-QID
Ketorolak Inhibisi enzim Dosis intermiten: 15- Risiko gagal ginjal Hindari pada disfungsi
siklooksigenasi 1 30 mg IV/IM setiap Perdarahan ginjal, perdarahan
dan 2 yang 6-8 jam, maksimum gastrointestinal dan
reversibel 5 hari kelainan trombosit
Ibuprofen Inhibisi enzim Dosis oral: 400 mg Risiko gagal ginjal Hindari pada disfungsi
siklooksigenasi 1 setiap 6 jam (maks Perdarahan ginjal, perdarahan
dan 2 yang 2,4 g/hari) gastrointestinal dan
reversibel Dosis intermiten: kelainan trombosit
400-800mg IV setiap
6 jam (maks 3,2
g/hari)
Lidokain Penghambat Dosis muatan : 1,5 Bradikardi Pantau kadar obat
saluran natrium mg/kg IV Hipertensi (normal <4mcg/mL)
Infus: 0,5-2,5 Hipotensi Kerja memanjang pada
mg/kg/jam Penglihatan kabur gagal jantung kongestif,
Gemetar penyakit hati, syok dan
gangguan ginjal
Disadur dari kepustakaan Ammar et al. Journal of Intensive Care Medicine.2020

.

.


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PEDOMAN TATALAKSANA

Dilarang memperbanyak, mencetak dan menerbitkan sebagian atau seluruh

Perhimpunan Dokter Paru Indonesia (PDPI)

Jakarta, Januari 2022

Pedoman Tatalaksana COVID-19

seafood live market

Pedoman Tatalaksana COVID-19

in silico docking studies

Pedoman Tatalaksana COVID-19

host World Health Organization

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

S-Gene Target Failure

European Centre for Disease Prevention and

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Acute Respiratory Distress Syndrome

Pedoman Tatalaksana COVID-19

Cycle Threshold (CT) value

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Isolasi Kasus COVID 19 asimtomatis dan gejala ringan

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

High Flow Nasal Cannula

Pedoman Tatalaksana COVID-19

Awake Prone Position

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

plateau pressure driving

Pedoman Tatalaksana COVID-19

Extra Corporeal Membrane Oxygenation (

Clinical Frailty Scale

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

D-dimer meningkat secara nyata*** 1. D-dimer tidak meningkat secara nyata***

1. Produk darah sesuai protokol (Iihat “Catatan”)

Pada pasien dengan gejala perdarahan, pertahankan

Pedoman Tatalaksana COVID-19

Antithrombotic Therapy and Prevention of

low molecular weight

Pedoman Tatalaksana COVID-19

(a) intermediate low-intensity

American Society of Hematology

American Society of Hematology

Pedoman Tatalaksana COVID-19

Pedoman Tatalaksana COVID-19

Emergency Use Authorisation/EUA

Food and Drug Administration

D-dimer meningkat secara nyata* 1. D-dimer tidak meningkat secara nyata*