Efektivitas Pemberian Resusitasi Cairan 30cc/Kgbb Bersamaan dengan Pemberian Norepinefrin Terhadap Pencegahan Cedera Ginjal Akut Pada Pasien Syok Sepsis

Abstract

Background: Septic shock is a severe form of sepsis characterized by refractory hypotension and impaired organ perfusion, including acute kidney injury (AKI), which significantly increases morbidity and mortality. Effective management of septic shock emphasizes the importance of early fluid resuscitation and vasopressor use—particularly norepinephrine—to stabilize hemodynamics and prevent organ damage. However, the effectiveness of this combined intervention in preventing AKI still requires further evidence, especially within the context of clinical practice in Indonesia. Objective: To evaluate the effectiveness of administering 30 cc/kgBW fluid resuscitation combined with norepinephrine as prevention of AKI in patients with septic shock. Methods: This one-group pretest-posttest study involved 100 septic shock patients in the ICUs of several hospitals in Medan. All subjects received 30 cc/kgBW of Ringer’s lactate and norepinephrine (0.05 µg/kg/min). Parameters including respiratory rate (RR), heart rate (HR), oxygen saturation (SpO₂ ), mean arterial pressure (MAP), urea, creatinine, blood urea nitrogen (BUN), urine output (UOP), and central venous pressure (CVP) were assessed before and 48 hours after intervention. The Wilcoxon test was used for analysis (p<0.05) Results: The median values showed significant improvements: MAP increased from 59 to 73 mmHg, systolic BP (SBP) from 76 to 94 mmHg, diastolic BP (DBP) from 50 to 62 mmHg, SpO₂ from 93.5% to 97%, heart rate (HR) decreased from 121 to 92 bpm, and respiratory rate (RR) from 32 to 16 breaths/min (p=0.0001). Renal parameters showed stabilization: urea from 24.5 to 25 mg/dL, creatinine remained at 0.8 mg/dL, and BUN increased slightly from 11.5 to 12 mg/dL. Urine output increased from 29 to 35.5 mL/h, and central venous pressure (CVP) from 9 to 11 mmHg (p=0.0001). The rapid hemodynamic improvement within 15–30 minutes post-intervention indicates an effective early response, supporting the 2021 Surviving Sepsis Campaign (SSC) guidelines and previous clinical trials on the benefit of early norepinephrine administration. However, close hemodynamic monitoring remains essential to prevent adverse effects such as microcirculatory hypoperfusion or fluid overload. Conclusions: The combination of 30 cc/kgBW fluid resuscitation with norepinephrine was effective in improving hemodynamic parameters and reducing AKI incidence within the first 48 hours in septic shock patients, with improvements in blood pressure, tissue perfusion, and kidney function. These findings support the application of early aggressive therapy protocols aligned with SSC guidelines to reduce the risk of organ failure.