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  • Monitoring Terapi Cairan

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    neonatus merak
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    This document discusses volume kinetics for infusion fluids and crystalloid resuscitation. It notes that crystalloids leave the plasma space and equilibrate with the interstitial space after 20-30 minutes, with 75-80% leaving the vasculature after 20 minutes. Aggressive fluid strategies can adversely affect every system and organ by causing tissue edema and cellular damage leading to organ dysfunction. The Frank-Starling curve shows that preload-independence occurs when further increases in preload do not increase stroke volume, and may decrease it, causing low cardiac output. Practical ways to assess fluid adequacy include passive leg raises and measuring the inferior vena cava. Fluid overload is calculated as fluids in minus

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    This document discusses volume kinetics for infusion fluids and crystalloid resuscitation. It notes that crystalloids leave the plasma space and equilibrate with the interstitial space after 20-30 minutes, with 75-80% leaving the vasculature after 20 minutes. Aggressive fluid strategies can adversely affect every system and organ by causing tissue edema and cellular damage leading to organ dysfunction. The Frank-Starling curve shows that preload-independence occurs when further increases in preload do not increase stroke volume, and may decrease it, causing low cardiac output. Practical ways to assess fluid adequacy include passive leg raises and measuring the inferior vena cava. Fluid overload is calculated as fluids in minus

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    5 views12 pages

    Monitoring Terapi Cairan

    Uploaded by

    neonatus merak
    This document discusses volume kinetics for infusion fluids and crystalloid resuscitation. It notes that crystalloids leave the plasma space and equilibrate with the interstitial space after 20-30 minutes, with 75-80% leaving the vasculature after 20 minutes. Aggressive fluid strategies can adversely affect every system and organ by causing tissue edema and cellular damage leading to organ dysfunction. The Frank-Starling curve shows that preload-independence occurs when further increases in preload do not increase stroke volume, and may decrease it, causing low cardiac output. Practical ways to assess fluid adequacy include passive leg raises and measuring the inferior vena cava. Fluid overload is calculated as fluids in minus

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    Download as pptx, pdf, or txt
    of 12

    TERAPI CAIRAN

    Arifin
    VOLUME KINETICS FOR INFUSION FLUIDS
    capillary cell
    membrane membrane

    Mineral, protein,
    ECW ICW gycogen, fat
    20% 40% 40%

    Plasma Interstitial o CRYSTALLOID LEAVES THE PLASMA SPACE,


    Volume 4.3% fluid 15.7%
    EQUILIBRATES WITH INTERSTITIAL SPACE AFTER 20-
    30 MIN
    colloids
    crystalloid:
    75-80% leaves vasculature after 20 minutes

    5% dextrose
    Hahn GR, Anesthesiology 2010
    VOLUME KINETIC OF CRYSTALLOID CRYSTALLOID
    RESUSCITATION
    RESUSCITATION
    INTACT GLYCOCALIX

    ARDS Hydrostatic

    20-30 min
    Osmotic

    after
    Peripheral 75-80%
    edema

    Burst

    INTERSTITIAL INTRAVASCULAR
    INTRACELLULAR

    Endothelial Surface layer (Glycocalix)


    Endothelial Capillary Junction

    Hahn GR, Anesthesiology 2010


    Tanda
    &
    gejala

    • Edema palpebra
    • Edema
    ekstremitas
    • Takikardia
    • Sesak napas
    AGGRESSIVE FLUID STRATEGIES
    ADVERSELY AFFECT EVERY
    SYSTEM AND ORGAN

    THE KIDNEY PARADOX;


    (oliguria worsened by
    Tissue Edema fluid challenge)

    Diffusion Distance

    Celullar damage
    (ORGAN DYSFUNCTION)

    FLUID ACCUMULATION AND MULTI ORGAN DYSFUNCTION


    Prowle JR et al. Nat Rev Nephrol 2010;6:107
    FRANK STARLING CURVE IN CRITICALLY
    ILL FLUID MANAGEMENT
    flat

    Preload-Independence =
    Artinya, setiap peningkatan preload pada area
    ini TIDAK akan meningkatkan stroke volume,
    bahkan dapat menurunkan stroke volume yg
    steep
    Will increase the stroke volume
    akan menyebabkan “low cardiac output”
    Stroke Volume

    Preload-dependence =
    Artinya, setiap peningkatan preload by volume
    loading pada area ini akan meningkatkan stroke
    volume, sehingga cardiac output akan meningkat

    Every increasing preload by volume loading

    Preload
    Cara praktis menilai
    kecukupan cairan

    PLR

    IVC
    Fluid Challenge Technic

    Blood shift equivalent


    to 250 – 300 ml volume

    4545° °
    Cara menghitung fluid
    overload

    CAIRAN MASUK – CAIRAN KELUAR


    % FLUID
    OVERLOA 100
    D
    BERAT BADAN SAAT MASUK
    ICU
    Kesimpulan
    Resusitasi merupakan upaya penyelamatan hidup
    Diperlukan parameter objektif untuk menilai target
    resusitasi
    Fluid overload meningkatkan morbiditas dan
    mortalitas pada pasien sakit kritis
    Maturnuwun

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