De-resusitasi: Konsep ROSE
DOI:
https://doi.org/10.55175/cdk.v46i3.502Keywords:
De-resusitasi, kelebihan cairan, konsep ROSE, terapi cairanAbstract
Sepsis berkaitan dengan cedera endotel generalisata dan kebocoran kapiler; secara umum diterapi dengan resusitasi cairan bervolume besar. Early-goal-directed therapy (EGDT) terdiri dari resusitasi cairan awal agresif yang meningkatkan angka bertahan hidup pada sepsis. Namun, resusitasi cairan agresif dapat mengarah pada kelebihan cairan yang dikaitkan dengan peningkatan morbiditas dan mortalitas. Keseimbangan cairan kumulatif positif dikaitkan dengan hasil akhir buruk. Pada pasien yang tidak melewati fase ebb ke fase flow pada syok secara spontan, harus dipertimbangkan late conservative uid management dan late goal-directed fuid removal (de-resusitasi).
Sepsis is associated with generalised endothelial injury and capillary leak and has traditionally been treated with large volume fluid resuscitation. Early-goal directed therapy (EGDT) consists of early, aggressive fluid resuscitation and is known to improve survival in sepsis. However, aggressive fluid resuscitation can lead to fluid overload associated with increased morbidity and mortality. A positive cumulative fluid balance is associated with worse outcomes. Late conservative fluid management and late-goal directed fluid removal (de-resuscitation) should be considered in patients who do not transgress spontaneously from the ebb to flow phases of shock
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