Tesis

Efektivitas Goal Directed Fluid Therapy Menggunakan Cardiac Index Dibandingkan Tekanan Vena Sentral pada Pasien Pascaoperasi Abdomen Mayor di ICU = The Effectiveness of Goal-Directed Fluid Therapy Guided by Cardiac Index Compared to Central Venous Pressure in Post– Major Abdominal Surgery Patients in the ICU.

Pendahuluan: Operasi abdomen mayor seringkali dikaitkan dengan ketidakstabilan hemodinamik, perpindahan cairan dan potensi komplikasi perioperatif. Secara tradisional, terapi cairan dipandu oleh parameter statis seperti tekanan vena sentral (CVP), namun CVP memiliki keterbatasan memprediksi respons cairan dibandingkan parameter dinamis. Goal-Directed Fluid Therapy (GDFT) menggunakan parameter dinamis seperti cardiac index untuk mengoptimalkan perfusi jaringan. Penelitian ini bertujuan mengevaluasi efektivitas GDFT menggunakan cardiac index dibandingkan CVP terhadap jumlah cairan pada pasien pascaoperasi abdomen mayor di ICU Metode: Penelitian ini merupakan studi eksperimental acak tersamar tunggal. Sebanyak 60 subjek penelitian pasca operasi abdomen mayor di RSUPN Cipto Mangunkusumo pada periode Desember 2025 – Februari 2026 yang dimasukkan ke kelompok goal directed fluid therapy dengan target cardiac index dan tekanan vena sentral. Luaran penelitian berupa penggunaan jumlah cairan selama 6 jam pascaoperasi. Hasil: Sebanyak 60 subjek dengan masing-masing kelompok berjumlah 30 subjek yang mengikuti penelitian hingga akhir dan dianalisis. Jumlah cairan 6 jam pada kelompok CI 549  146,8 ml vs kelompok CVP 599  201,6 ml (p 0,279). Lama rawat ICU pada kedua kelompok sama dengan median 2 hari dan lama rawat rumah sakit dengan median 7,5 dan 7 hari. Angka mortalitas RS total pada seluruh pasien adalah 6 pasien (10%), dengan rincian 2 pasien (6,7%) di kelompok CI dan 4 pasien di kelompok CVP (13,3%). Terdapat 19 pasien hipotensi yang mendapatkan bolus cairan, 10 pasien di kelompok Cardiac Index dan 9 pasien di kelompok tekanan vena sentral (33,3% vs 30%). Simpulan: Tidak terdapat perbedaan jumlah cairan 6 jam yang bermakna pada pasien dengan target cardiac index maupun CVP
Kata kunci: goal directed fluid therapy, cardiac index, CVP


Background: Major abdominal surgery is associated with hemodynamic instability, fluid shifts, and perioperative complications. Fluid therapy traditionally guided by central venous pressure (CVP) has limited ability to predict fluid responsiveness. Goal-Directed Fluid Therapy (GDFT), using dynamic parameters such as cardiac index, aims to optimize tissue perfusion and improve outcomes. This study evaluated the effectiveness of cardiac index–guided GDFT compared with CVP in post–major abdominal surgery patients in the ICU. Methods: This study was a single-blinded randomized experimental trial conducted at Cipto Mangunkusumo National General Hospital between December 2025 and February 2026. A total of 60 patients were randomly assigned into two groups: cardiac index– guided GDFT and CVP-guided therapy, with 30 patients in each group. The primary outcome was total fluid administration within the first 6 postoperative hours. Results: All 60 patients completed the study and were included in the analysis. The mean 6-hour fluid volume was 549 ± 146.8 mL in the cardiac index group and 599 ± 201.6 mL in the CVP group (p = 0.279). Median ICU length of stay was 2 days in both groups, while median hospital length of stay was 7.5 days and 7 days, respectively. In-hospital mortality was 10%, with 2 patients (6.7%) in the cardiac index group and 4 patients (13.3%) in the CVP group. Hypotension requiring fluid bolus occurred in 10 patients (33.3%) in the cardiac index group and 9 patients (30%) in the CVP group. Conclusion: There was no significant difference in 6-hour fluid administration between two groups
Keywords: goal directed fluid therapy, cardiac index, CVP