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