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Introduction FLUID

This document discusses fluid therapy and summarizes key points about fluid balance and mortality in patients. It notes that positive fluid balance and elevated central venous pressure are associated with increased mortality in septic shock patients. The document also states that fluid administration is often an initial response to indications of tissue hypoperfusion, but that only about 50% of hemodynamically unstable ICU patients are likely to be volume responsive. It discusses the relationship between fluid volume, cardiac output, electrolyte content, and acid-base balance according to Stewart's model of acid-base physiology.

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37 views13 pages

Introduction FLUID

This document discusses fluid therapy and summarizes key points about fluid balance and mortality in patients. It notes that positive fluid balance and elevated central venous pressure are associated with increased mortality in septic shock patients. The document also states that fluid administration is often an initial response to indications of tissue hypoperfusion, but that only about 50% of hemodynamically unstable ICU patients are likely to be volume responsive. It discusses the relationship between fluid volume, cardiac output, electrolyte content, and acid-base balance according to Stewart's model of acid-base physiology.

Uploaded by

erzaraptor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Introduction

Fluid Therapy

Ike SR
Distribusi cairan tubuh
Na = 140 meq/l total cairan tubuh  60% BB

Capillary membrane
K = 4 meq/l

Na = 140 meq/l
K = 4 meq/l

Cell membrane
Intra Cellular Space
Intravascular Space

5% 40%
Na = 8 meq/l
15% K = 151 meq/l

RBC Interstitial
Space
Glucose solution

Colloid crystalloids
Delivery O2 ( pengangkutan O2)
Cardiac Output x Hb x SpO2 x 1,34 + (PaO2 x 0,003)

Stroke Volume x HR

iv Volume & Contractility


GOAL - DIREDECT THERAPY
FLUID BALANCE & MORTALITY
• Rosenberg AL et al. Review of a large clinical series: association of cumula
tive fluid balance on outcome in acute lung injury: a retrospective review of
the ARDSnet tidal volume study cohort. JICM 2009; 24:35-46

• Boyd JH et al. Fluid resuscitation in septic shock: a positive fluid balance a


nd elevated central venous pressure increase mortality. CCM 2011; 39 (2):
259-61

• Bellomo R et al. An observational study fluid balance and patient outcomes


in the Randomized Evaluation of Normal vs Augmented Level of Replacem
ent Therapy trial. CCM 2012; 40 (6): 1753-60
OFTEN THE 1ST STEP …

• Fluid administration is frequently initial response to


indicators of tissue hypoperfusion

• However, it is likely that only 50% of haemodynamical


ly unstable ICU patients are volume responsive

Marik PE et al. Dynamic changes in arterial waveform derived variabl


es and fluid responsiveness in mechanically ventilated patients. A syst
ematic review of the literature. CCM 2009; 37: 2642-2647
Fluid Responsiveness

• Ventilasi ↔ hemodynamic  heart lung interaction


• Intravaskular volume  CVP  ?  How ?
Menurut Stewart

pH atau [H+] DALAM PLASMA


DITENTUKAN OLEH

DUA VARIABEL

VARIABEL VARIABEL
INDEPENDEN DEPENDEN

PCO2, SID, Weak Acid

Stewart PA. Can J Physiol Pharmacol 61:1444-1461, 1983.


Apa yang terjadi ?
• Volume  berpengaruh terhadap CO
• Kandungan elektrolit  mempengaruhi
keseimbangan asam basa  SID ( strong Ion
Difference )
• SID adalah perbedaan antara konsentrasi
Ion + …dan Ion –
• SID normal 38 – 42  makin kesil makin asam
• NaCl 0,9 %  Na 154 meq dan Cl 154 meq 
SID nya = 0  cairan yang asam
• pH NaCl 0,9% = 6,..  asam
• Osmolaritas  juga penting  keluar masuk
cairan ke intraselular
Ringerfundin – SID (Strong Ion Different)

Plasma

Na+ = 142 mEq/L


Cl- = 103 mEq/L

SID = 38 mEq/L

+ Ringerfundin Osm 300


+ NaCl 0.9% osm 300 + RL osm 275

Plasma Plasma Plasma

Na+ = (142+154)/2 mEq/L= 147 mEq/L Na+ = (140+130)/2 mEq/L= 135 mEq/L Na+ = (140+142)/2 mEq/L= 141 mEq/L
Cl- = (103+127)/2 mEq/L= 115 mEq/L
Cl- = (103+ 154)/2 mEq/L= 128 mEq/L Cl- = (103+ 112)/2 mEq/L= 107 mEq/L
Asetat & Malat
Laktat (termetabolisme) = 0 mEq/L
(termetabolisme) = 0 mEq/L

SID = 19 mEq/L SID = 28 mEq/L SID = 26 mEq/L


12
SID : 19  Asidosis SID : 28 SID : 26

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