Tesis

Pengaruh Pemberian Dini Norepinefrin Pada Tatalaksana Pasien Dengan Syok Septik: Penilaian Terhadap Durasi Hipotensi, Kadar Laktat, Saturasi Vena Sentral, Profil Hemodinamik, Dan Skor Sofa = The Effect of Early Norepinephrine Administration in the Management of Patients with Septic Shock: An Evaluation of Hypotension Duration, Lactate Levels, Central Venous Oxygen Saturation, Hemodynamic Profile, and SOFA Score.

Latar belakang: Resusitasi cairan menjadi landasan utama penatalaksanaan awal utama pada syok sepsis, namun seringkali menyebabkan vasoplegia berat, penurunan tonus pembuluh darah dan perfusi jaringan. Kelebihan cairan yang kerap terjadi pada protokol standar juga dikaitkan dengan luaran klinis yang buruk. Waktu pemberian norepinefrin sebagai vasopresor lini pertama masih menjadi perdebatan, pemberian secara dini dapat menurunkan mortalitas dan jumlah cairan yang digunakan, serta memperbaiki perfusi jaringan. Penelitian ini bertujuan untuk mengevaluasi pengaruh pemberian norepinefrin dini terhadap parameter klinis pasien syok septik. Metode: Uji klinis acak melibatkan 44 pasien syok sepsis di RSUD Cibinong. Kelompok perlakuan (n=22) mendapatkan norepinefrin 0,05 mcg/kg/menit bersama dengan cairan rumatan, sedangkan kontrol (n=22) mendapatkan norepinferin jika target mean arterial pressure ≥ 65 mmHg tidak tercapai pasca resusitasi cairan. Durasi hipotensi dicatat dalam 24 jam pertama. Skor Sequential Organ Failure Assessment (SOFA), kadar laktat, saturasi vena oksigen sentral (SCVO2), Thoracic Fluid Content (TFC), StrokeVolume Variation (SVV), dan Cardiac Contratility Index (CCI) dinilai pada 0, 1, 3, dan 24 jam pasca admisi. Hasil: Durasi hipotensi lebih singkat pada kelompok perlakuan dibandingkan kontrol (6,36 ± 2,46 vs 13,31 ± 4,41 menit; p < 0,001). Kelompok perlakuan memiliki skor SOFA, kadar laktat, SCVO2, TFC, SVV, dan CCI yang secara signifikan lebih baik pada 1, 3, dan 24 jam pasca admisi dibandingkan dengan kontrol. Kesimpulan: Terapi sepsis dengan pemberian norepinferin dini menghasilkan perbaikan klinis yang signifikan pada pasien syok sepsis.
Kata Kunci: Norepinferin dini, syok sepsis, hipotensi, laktat, hemodinamik, skor SOFA


Background: Fluid resuscitation is the cornerstone of initial management in septic shock; however, it often results in severe vasoplegia, reduced vascular tone, and impaired tissue perfusion. Fluid overload, frequently observed under standard protocols, is associated with poorer clinical outcomes. The timing of norepinephrine administration as the first-line vasopressor remains debated. Early administration may reduce mortality, decrease fluid requirements, and improve tissue perfusion. This study aimed to evaluate the effect of early norepinephrine administration on clinical parameters in septic shock patients. Metodhs: A randomized clinical trial was conducted involving 44 patients with septic shock in the RSUD Cibinong. The treatment group (n=22) received norepinephrine at 0.05 mcg/kg/min along with maintenance fluids, whereas the control group (n=22) received norepinephrine only if the target mean arterial pressure (MAP) ≥ 65 mmHg was not achieved after fluid resuscitation. Hypotension duration was recorded within the first 24 hours. Sequential Organ Failure Assessment (SOFA) score, lactate levels, central venous oxygen saturation (ScvO₂), thoracic fluid content (TFC), stroke volume variation (SVV), and cardiac contractility index (CCI) were measured at 0, 1, 3, and 24 hours post-admission. Results: The treatment group showed a significantly shorter duration of hypotension compared to the control group (6.36 ± 2.46 vs 13.31 ± 4.41 minutes; p < 0.001). Additionally, the treatment group demonstrated significantly better SOFA scores, lactate levels, ScvO₂, TFC, SVV, and CCI at 1, 3, and 24 hours postadmission compared to the control group. Conclusion: Sepsis management with early norepinephrine administration results in significant clinical improvement in patients with septic shock.
Keywords: early norepinephrine, septic shock, hypotension, lactate, hemodynamic, SOFA score