PERBANDINGAN EFEK ANTARA CAIRAN RINGER LAKTAT, KOMBINASI RINGER LAKTAT DAN HES 6%, SERTA RINGER LAKTAT DAN GELOFUSINE PADA RESUSITASI LANJUT PASIEN SYOK HEMORAGIK=COMPARISON OF EFFECTS BETWEEN RINGER LACTATE SOLUTION, COMBINATION OF RINGER LACTATE AND HES 6%, AND RINGER LACTATE AND GELOFUSINE IN ADVANCED RESUSCITATION OF PATIENTS WITH HEMORRHAGIC SHOCK

Rachmad Ismail: Comparison of Effects Between Ringer Lactate Solution, Combination of Ringer Lactate and HES 6%, and Ringer Lactate and Gelofusine in Advanced Resuscitation of Patients with Hemorrhagic Shock Objective: To compare the resuscitative effects of Ringer’s lactate (RL), RL combined with 6% hydroxyethyl starch 130/0.4 (RLH), and RL combined with gelofusine (RLG) on blood lactate and neutrophil gelatinase-associated lipocalin (NGAL) levels in patients with hemorrhagic shock. Design: A quantitative, analytical, prospective cohort study. Setting: A tertiary care hospital operating room setting where patients experienced intraoperative hemorrhagic shock. Patient and participants: Patients who met clinical criteria for hemorrhagic shock and received fluid resuscitation with RL, RLH, or RLG. Consecutive sampling was applied, with baseline and 12-hour post-resuscitation measurements collected. Interventions: Fluid resuscitation using one of three regimens: RL alone, RL + HES 6% (130/0.4) with a 2:1 ratio, or RL + gelofusine with a 2:1 ratio. Measurements and results: Blood lactate and NGAL were measured before (T0) and 12 hours after resuscitation (T1). All three regimens produced significant reductions in lactate and NGAL levels (p < 0.001). The most significant decrease in lactate was observed in the RL group (−3.30 ± 0.88 mmol/L), followed by RLG (−3.10 ± 0.57 mmol/L) and RLH (−2.61 ± 0.91 mmol/L), with no statistically significant difference among groups (p = 0.067). NGAL also declined significantly in all groups, with RL showing the most significant decrease (−6,288.63 ± 14,218.55 ng/mL), followed by RLG (−2,030.73 ± 2,383.25 ng/mL) and RLH (−978.84 ± 765.31 ng/mL); however, intergroup differences were not significant (p = 0.655). Conclusions: RL, RLH, and RLG are all effective in improving microcirculatory markers in hemorrhagic shock, as reflected by significant decreases in lactate and NGAL levels. These findings indicate that all three strategies offer comparable biochemical benefits in early hemorrhagic shock resuscitation. Keywords: Fluid resuscitation, Gelofusine, Hydroxyethyl starch, Hemorrhagic shock, Ringer’s lactate.