Pengaruh Pemberian Dini Norepinefrin Pada Tatalaksana Pasien Dengan Syok Septik: Penilaian Terhadap Durasi Hipotensi, Kadar Laktat, Saturasi Vena Sentral, Profil Hemodinamik, Dan Skor Sofa

Abstract

Septic shock induce severe vasoplegia, reduced vascular tone, and impaired tissue perfusion. The timing of norepinephrine administration as the first-line vasopressor remains debated. This study aimed to evaluate the effect of early norepinephrine administration on clinical parameters in septic shock patients. 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. 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 post-admission compared to the control group. Sepsis management with early norepinephrine administration results in significant clinical improvement in patients with septic shock.