MONITORING TERAPI CAIRAN PADA KASUS EMERGENSI: TINJAUAN KOMPREHENSIF PENDEKATAN DINAMIS TERKINI: FLUID THERAPY MONITORING IN EMERGENCY CASES: A COMPREHENSIVE REVIEW OF THE LATEST DYNAMIC APPROACH - Agus Sumedi; Zaim Anshari (Fakultas Kedokteran Universitas Islam Sumatera Utara, 2026)
Fluid therapy is a cornerstone of resuscitation in emergency patients, but conventional approaches based on static parameters such as central venous pressure and isolated clinical signs have proven insensitive and frequently trigger fluid overload, which directly correlates with increased mortality and multi-organ failure. This article aims to comprehensively review the evolution of fluid therapy monitoring strategies, focusing on dynamic parameters and Point-of-Care Ultrasound (POCUS) in emergency departments and intensive care units based on current clinical evidence. A narrative review was conducted on 26 reputable scientific literatures (Scopus Q1/Q2 and international guidelines) published between 2018–2026 regarding the accuracy of dynamic parameters, functional tests, and ultrasonography in predicting fluid responsiveness. The results demonstrate that determining fluid responsiveness using dynamic parameters—such as Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) with an accuracy >13%—is far superior to static parameters. For spontaneously breathing patients, the Passive Leg Raising (PLR) test proves safe and reversible. Integration of POCUS through evaluation of Inferior Vena Cava collapsibility and Carotid Artery Flow Time provides real-time visualization of circulatory volume status at the bedside. Implementation of a phase-based resuscitation protocol (the ROSE concept) guided by dynamic parameters, along with a post-resuscitation restrictive strategy, has been shown to reduce the incidence of acute kidney injury and the duration of mechanical ventilation. In conclusion, fluid monitoring based on dynamic parameters and POCUS is strongly recommended to replace conventional linear resuscitation dogma in order to reduce morbidity and mortality in emergency patients. AbstrakTerapi cairan merupakan pilar utama resusitasi pasien emergensi, namun pendekatan konvensional berbasis parameter statis seperti tekanan vena sentral dan tanda klinis terisolasi terbukti tidak sensitif dan sering memicu fluid overload yang berkorelasi langsung dengan peningkatan mortalitas serta kegagalan multi-organ. Artikel ini bertujuan menelaah secara komprehensif evolusi strategi monitoring terapi cairan dengan fokus pada parameter dinamis dan Point-of-Care Ultrasound (POCUS) di instalasi gawat darurat dan ruang intensif berdasarkan bukti klinis literatur terkini. Metode yang digunakan secara komprehensif terhadap 26 literatur ilmiah bereputasi (Scopus Q1/Q2 dan panduan internasional) kurun waktu 2018–2026 terkait akurasi parameter dinamis, uji fungsional, dan ultrasonografi dalam memprediksi responsivitas cairan. Hasil tinjauan menunjukkan bahwa penentuan responsivitas cairan menggunakan parameter dinamis seperti Pulse Pressure Variation (PPV) dan Stroke Volume Variation (SVV) dengan akurasi >13% jauh lebih unggul dibanding parameter statis. Bagi pasien bernapas spontan, uji Passive Leg Raising (PLR) terbukti aman dan reversibel. Integrasi POCUS melalui evaluasi kolapsibilitas Vena Cava Inferior serta parameter Carotid Artery Flow Time memberikan visualisasi status volume sirkulasi secara real-time di tempat tidur pasien. Implementasi protokol resusitasi berbasis fase (konsep ROSE) yang dipandu parameter dinamis serta strategi restriktif pasca-resusitasi terbukti menurunkan kejadian cedera ginjal akut dan durasi ventilasi mekanik. Sebagai kesimpulan, monitoring cairan berbasis parameter dinamis dan POCUS sangat direkomendasikan untuk menggantikan dogma resusitasi linier konvensional demi menurunkan morbiditas dan mortalitas pasien emergensi.