MONITORING TERAPI CAIRAN PADA KASUS EMERGENSI: TINJAUAN KOMPREHENSIF PENDEKATAN DINAMIS TERKINI
FLUID THERAPY MONITORING IN EMERGENCY CASES: A COMPREHENSIVE REVIEW OF THE LATEST DYNAMIC APPROACH
Abstract
Fluid therapy is a cornerstone of resuscitation in emergency patients, but conventional approaches based on static parameters such as central venous pressure and isolated clinical signs have proven insensitive and frequently trigger fluid overload, which directly correlates with increased mortality and multi-organ failure. This article aims to comprehensively review the evolution of fluid therapy monitoring strategies, focusing on dynamic parameters and Point-of-Care Ultrasound (POCUS) in emergency departments and intensive care units based on current clinical evidence. A narrative review was conducted on 26 reputable scientific literatures (Scopus Q1/Q2 and international guidelines) published between 2018–2026 regarding the accuracy of dynamic parameters, functional tests, and ultrasonography in predicting fluid responsiveness. The results demonstrate that determining fluid responsiveness using dynamic parameters—such as Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) with an accuracy >13%—is far superior to static parameters. For spontaneously breathing patients, the Passive Leg Raising (PLR) test proves safe and reversible. Integration of POCUS through evaluation of Inferior Vena Cava collapsibility and Carotid Artery Flow Time provides real-time visualization of circulatory volume status at the bedside. Implementation of a phase-based resuscitation protocol (the ROSE concept) guided by dynamic parameters, along with a post-resuscitation restrictive strategy, has been shown to reduce the incidence of acute kidney injury and the duration of mechanical ventilation. In conclusion, fluid monitoring based on dynamic parameters and POCUS is strongly recommended to replace conventional linear resuscitation dogma in order to reduce morbidity and mortality in emergency patients.
Abstrak
Terapi cairan merupakan pilar utama resusitasi pasien emergensi, namun pendekatan konvensional berbasis parameter statis seperti tekanan vena sentral dan tanda klinis terisolasi terbukti tidak sensitif dan sering memicu fluid overload yang berkorelasi langsung dengan peningkatan mortalitas serta kegagalan multi-organ. Artikel ini bertujuan menelaah secara komprehensif evolusi strategi monitoring terapi cairan dengan fokus pada parameter dinamis dan Point-of-Care Ultrasound (POCUS) di instalasi gawat darurat dan ruang intensif berdasarkan bukti klinis literatur terkini. Metode yang digunakan secara komprehensif terhadap 26 literatur ilmiah bereputasi (Scopus Q1/Q2 dan panduan internasional) kurun waktu 2018–2026 terkait akurasi parameter dinamis, uji fungsional, dan ultrasonografi dalam memprediksi responsivitas cairan. Hasil tinjauan menunjukkan bahwa penentuan responsivitas cairan menggunakan parameter dinamis seperti Pulse Pressure Variation (PPV) dan Stroke Volume Variation (SVV) dengan akurasi >13% jauh lebih unggul dibanding parameter statis. Bagi pasien bernapas spontan, uji Passive Leg Raising (PLR) terbukti aman dan reversibel. Integrasi POCUS melalui evaluasi kolapsibilitas Vena Cava Inferior serta parameter Carotid Artery Flow Time memberikan visualisasi status volume sirkulasi secara real-time di tempat tidur pasien. Implementasi protokol resusitasi berbasis fase (konsep ROSE) yang dipandu parameter dinamis serta strategi restriktif pasca-resusitasi terbukti menurunkan kejadian cedera ginjal akut dan durasi ventilasi mekanik. Sebagai kesimpulan, monitoring cairan berbasis parameter dinamis dan POCUS sangat direkomendasikan untuk menggantikan dogma resusitasi linier konvensional demi menurunkan morbiditas dan mortalitas pasien emergensi.
References
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063-e1143.
Vincent JL, Weil MH. Fluid challenge revisited. Crit Care Med. 2006;34(5):1333-1337.
Malbrain MLNG, Van Regenmortel N, Saugel B, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66.
Hidayati W, Ifadah E, Judijanto L, Usu SQ. Asuhan Keperawatan Pada Pasien Dengan Hipervolemia. Green Pustaka Indonesia; 2025.
Ripollés-Melchor J, Espinosa Á V, Monge-García MI. Perioperative fluid management: why one-size-fits-all strategies are insufficient in high-risk patients. Comment on Br J Anaesth 2024; 133: 1263-75. Br J Anaesth. 2025;134(2):592-594.
Myburgh JA. Fluid resuscitation in acute medicine: what is the current situation? J Intern Med. 2015;277(1):58-68.
Messina A, Pelaia C, Bruni A, et al. Fluid challenge during anesthesia: a systematic review and meta-analysis. Anesth Analg. 2018;127(6):1353-1364.
Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016;6(1):111.
Bauer SR, Gellatly RM, Erstad BL. Precision fluid and vasoactive drug therapy for critically ill patients. Pharmacother J Hum Pharmacol Drug Ther. 2023;43(11):1182-1193.
Liu Y, Wei L qing, Li G qiang, Yu X, Li G feng, Li Y ming. Pulse pressure variation adjusted by respiratory changes in pleural pressure, rather than by tidal volume, reliably predicts fluid responsiveness in patients with acute respiratory distress syndrome. Crit Care Med. 2016;44(2):342-351.
Osterwalder J, Polyzogopoulou E, Hoffmann B. Point-of-care ultrasound—history, current and evolving clinical concepts in emergency medicine. Medicina (B Aires). 2023;59(12):2179.
Zieleskiewicz L, Muller L, Lakhal K, et al. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med. 2015;41(9):1638-1647.
Ferrari R. Writing narrative style literature reviews. Med Writ. 2015;24(4):230-235.
Maurer C, Wagner JY, Schmid RM, Saugel B. Assessment of volume status and fluid responsiveness in the emergency department: a systematic approach. Medizinische Klin und Notfallmedizin. 2017;112(4):326-333.
Lim HS. Law of the Heart. In: Hemodynamic Physiology in Advanced Heart Failure and Cardiogenic Shock. Springer; 2024:3-23.
Serrani M. The influence of cardiac trabeculae on ventricular mechanics. Published online 2014.
Sartika LD, Pradian E, Dian N, Sudjud RW, Aditya R. Hubungan Volume Cairan dengan Cardiac Output dan Venous Return pada Pasien Kritis. JAI (Jurnal Anestesiol Indones. 2019;11(3):164-177.
Moller PW, Winkler B, Hurni S, et al. Right atrial pressure and venous return during cardiopulmonary bypass. Am J Physiol Circ Physiol. Published online 2017.
Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of intravenous fluid in ICU patients with septic shock. N Engl J Med. 2022;386(26):2459-2470.
Macdonald SPJ, Keijzers G, Taylor DM, et al. Restricted fluid resuscitation in suspected sepsis associated hypotension (REFRESH): a pilot randomised controlled trial. Intensive Care Med. 2018;44(12):2070-2078.
Avital G, Snider EJ, Berard D, et al. Closed-loop controlled fluid administration systems: a comprehensive scoping review. J Pers Med. 2022;12(7):1168.
Aliun FW, Ifadah E, Natalia S. Keperawatan Gawat Darurat: Teori, Manajemen & Penerapan. PT. Sonpedia Publishing Indonesia; 2024.
Copyright (c) 2026 Agus Sumedi, Zaim Anshari
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
