Perbedaan Pengaruh Balanced dan Unbalanced Crystalloids sebagai Terapi Cairan pada Sepsis dan Syok Sepsis: a Systematic Review

Dimas Adjie Yuda Mahendra; Febrian Dwi Cahyo

doi:10.15851/jap.v9n1.2352

Perbedaan Pengaruh Balanced dan Unbalanced Crystalloids sebagai Terapi Cairan pada Sepsis dan Syok Sepsis: a Systematic Review

Dimas Adjie Yuda Mahendra, Febrian Dwi Cahyo

Abstract

Mortalitas sepsis dan syok sepsis hampir 20% per tahun dari semua kematian global. Sepsis dan syok sepsis merupakan penyebab 50% pasien dirawat di Intensive Care Unit (ICU). Kristaloid menjadi terapi cairan yang tepat menurut “The Surviving Sepsis Campaign Bundle: 2018 (SSC 2018)”. Kristaloid terbagi menjadi dua jenis, yaitu balanced dan unbalanced crystalloids. Perbedaan kandungan elektrolit keduanya dapat memengaruhi outcome pasien. Penelitian ini bertujuan mengetahui perbedaan pengaruh balanced dan unbalanced crystalloids pada sepsis dan syok sepsis dalam aspek mortalitas, kejadian hiperkloremia, dan lama tinggal di rumah sakit (RS). Metode yang digunakan adalah systematic review. Tempat penelitian berupa pencarian artikel penelitian pada online database dengan waktu penelitian, yaitu artikel dari tahun 2017 hingga 2021. Seleksi studi menggunakan PRISMA, kirteria restriksi dan PICO. Telaah artikel didapatkan 6 dari 249 artikel yang memenuhi syarat. Hasil analisis adalah mortalitas lebih rendah pada grup balanced crystalloids, kejadian hiperkloremia lebih tinggi pada unbalanced crystalloids, namun lama tinggal di RS di kedua grup tidak ada perbedaan signifikan. Simpulan penelitian adalah balanced crystalloids lebih efektif daripada unbalanced crystalloids dalam aspek menurunkan mortalitas dan kejadian hiperkloremia, namun tidak mengenai lama tinggal.

Differences in the Effect of Balanced and Unbalanced Crystalloids as Fluid Therapy in Sepsis and Septic Shock: A Systematic Review

Sepsis and septic shock contribute to almost 20% per year to the global total deaths. Sepsis and septic shock are also the the leading causes for patients to be treated in the Intensive Care Unit (ICU), with 50% of the patients treated in this unit due to sepsis and septic shock. Crystalloid is the appropriate thereapy for these conditions according to “The Surviving Sepsis Campaign Bundle: 2018 (SSC 2018)”. Crystalloids are divided into two types: balanced and unbalanced crystalloids. This study aimed to determine the difference between the effects of balanced and unbalanced crystalloids in sepsis and septic shock in terms of mortality, incidence of hyperchloremia, and length of stay in hospital. This was a systematic review on articles from the last five years using PRISMA, restriction criteria, and PICO. The review resulted in 6 out of 249 eligible articles. The results of the analysis demonstrated a lower mortality rate in the balanced crystalloids group while the incidence of hyperchloremia was higher in the unbalanced crystalloids group. No significant difference was found in the length of stay in hospital in both groups. Therefore, balanced crystalloids is more effective than unbalanced crystalloids in the aspect of reducing mortality and the incidence of hiperchloremia, with no significant difference in the length of stay in hospital.

Keywords

Balanced crystalloids, sepsis, syok sepsis, terapi cairan, unbalanced crystalloids

Full Text:

PDF

References

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, dkk. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock. Crit Care Med. : 2016;45:486–552.

Kempker JA, Martin GS. A global accounting of sepsis. Lancet [Internet]. 2020;395(10219):168–70 (diunduh 20 febuari 2021). Tersedia dari: http://dx.doi.org/10.1016/S0140-6736(19)33065-X.

Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intens Care Med [Internet]. 2018;44(6):925–8 (diunduh 20 febuari 2021). Tersedia dari: https://doi.org/10.1007/s00134-018-5085-0.

MacDonald N, Pearse RM. Are we close to the ideal intravenous fluid? Br J Anaesth [Internet]. 2017;119:i63–71 (diunduh 15 Januari 2021). Tersedia dari: http://dx.doi.org/10.1093/bja/aex293.

Semler MW, Kellum JA. Balanced crystalloid solutions. Am J Respir Crit Care Med. 2019;199(8):952–60.

Golla R, Kumar S, Dhibhar DP, Bhalla A, Sharma N. 0.9% saline V/S Ringer’s lactate for fluid resuscitation in adult sepsis patients in emergency medical services: An open-label randomized controlled trial. Hong Kong J Emerg Med. 2020;1(1):1–9.

Linares-Espinós E, Hernández V, Domínguez-Escrig JL, Fernández-Pello S, Hevia V, Mayor J, dkk. Methodology of a systematic review. Actas Urológicas Españolas (English Ed [Internet]. 2018;42(8):499–506 (diunduh tanggal 12 Januari 2021). Tersedia dari: http://dx.doi.org/10.1016/j.acuroe.2018.07.002.

Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, dkk. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.

Brown RM, Wang L, Coston TD, Krishnan NI, Casey JD, Wanderer JP, dkk. Balanced crystalloids versus saline in sepsis: a secondary analysis of the SMART clinical trial. Am J Respir Crit Care Med. 2019;200(12):1487–95.

Duffy RA, Foroozesh MB, Loflin RD, Ie SR, Icard BL, Tegge AN, dkk. Normal saline versus NormosolTM-R in sepsis resuscitation: a retrospective cohort study. J Intensive Care Soc [Internet]. 2019; 20(3):223–30 (diunduh tanggal 15 Febuari 2021). Tersedia dari: https://doi.org/10.1177/1751143718786113.

Jackson KE, Wang L, Casey JD, Bernard GR, Self WH, Rice TW, dkk. Effect of early balanced crystalloids before icu admission on sepsis outcomes. Chest [Internet]. 2020 (diunduh tanggal 11 Febuari 2021). Tersedia dari: https://doi.org/10.1016/j.chest.2020.08.2068.

Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, Stollings JL, dkk. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;12(1):152–63.

Sethi M, Owyang CG, Meyers C, Parekh R, Shah KH, Manini AF. Choice of resuscitative fluids and mortality in emergency department patients with sepsis. Am J Emerg Med [Internet]. 2018;36(4):625–9 (diunduh 20 Desember 2020). Tersedia dari: http://dx.doi.org/10.1016/j.ajem. 2017.09.042

Brown RM, Semler MW. Fluid management in sepsis. J Intens Care Med. 2019; 34(5):364–73.

Ali Rahman F, Fitriani Retno W, Calcarina, Yudo Pratomo B. Aplikasi klinis analisis gas darah pendekatan stewart pada periode perioperatif. J Komplikasi Anestesi [Internet]. 2015;3(November):69–80 (diunduh 15 Desember 2020). Tersedia dari: http://anestesi.fk.ugm.ac.id/jka.ugm /download-file-948305.pdf.

DOI: https://doi.org/10.15851/jap.v9n1.2352