Professional Documents
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Harimawan
Kamis, 25 Agustus 2015
OUTLINES
1. KONDISI KRITIS
2. DUKUNGAN NUTRISI : Jenis Nutrisi, Cara
Pemberian, Metode Pemberian, Kebutuhan
Energi, Waktu Pemberian, dan Komposisi
3. OPTIMALISASI NE
Definition Of Critical Illness
Critical illness is any disease process which causes
physiological instability leading to disability or death
within minutes or hours.
Stress Response
The bodys Attempt to promote healing and resolve
inflammation when homeostasis is disrupted
Dr Paul Frost is Consultant in Intensive Care Medicine. British Journal of Hospital Medicine, October 2007, Vol 68, No 10
PENYAKIT
CEDERA INFEKSI
KRITIS
RESPONS METABOLIK
Metabolic Response to Critical Illness
CADANGAN
ENERGI
INTERNATIONAL ANESTHESIOLOGY CLINICS. Volume 47, Number 1, 121138 @ 2009, Lippincott Williams & Wilkins
Metabolic Response to Critical Illness Cont.
MEDICAL NUTRITION THERAPY
SUCCESS
THERAPY
Radiotherapy
Antibiotic
Operation
Drugs
NUTRITION
Dikutip dari Presentasi Prof. DR. Dr. Eddy Rahardjo, SpAn KIC. 7
ICU : NUTRITION SUPPORT
Carmona Monge FJ, Martinez Lareo M, Garcia Gomez S, et al. effectiveness and safety of goal directed nurse-led blood glucose
control in an intensive care unit: a prospective observational study. Enferm Intensiva. 2012;23;11-16.
ICU : NUTRITION
NUTRITION SUPPORT
SUPPORT ---
Rationale :
Carmona Monge FJ, Martinez Lareo M, Garcia Gomez S, et al. effectiveness and safety of goal directed nurse-led blood glucose
control in an intensive care unit: a prospective observational study. Enferm Intensiva. 2012;23;11-16.
KONTRAINDIKASI PEMBERIAN NE
1. Acute Abdomen
2. Acute Gastrointestinal Bleediing
3. Mechanical Illeus
4. Intestinal Perforation
5. Persistent Attacks of Diarrhoea
6. Intestinal Obstruction
1. JENIS NUTRISI
NUTRISI ENTERAL
NO TIPE KETERANGAN
1 Intact/ Mengandung protein, bebas laktosa, dan kalori normal
Polymeric GIT berfungsi normal
2 Monomeric/ Protein bentuk dipeptida, tripeptida, dan/atau asam amino bebas,
Oligomeric/ Lemak, dan karbohidrat yang dicernakan sebelumnya; MCTs yang
Hydrolyzed/ tinggi dan rendah PUFAs
Elemental Gangguan saluran pencernaan yang berat
3 Diperkaya Mengandung tambahan serat dan/atau fructooligosaccharides
serat (FOS) untuk memperbaiki fungsi saluran cerna dan untuk
mengembalikan Integritas koloni
4 Modular Mengandung satu jenis zat gizi
Pelengkap
5 Khusus Dirancang untuk kondisi penyakit yang spesifik seperti ACKD,
PPOK, DM, dan Immunodefisiensi
NUTRISI PARENTERAL
1. ORAL
2. ENTERAL : Gastric,
Postpyloric
3. PARENTERAL :
Central, Perifer
4. KOMBINASI
3. Metode Pemberian Nutrisi
Enteral
I. CONTINOUS TUBE FEEDINGS:
Pemberian tetesan dengan pompa yang menyalurkan volume konstan
Pasien dgn gula darah tidak terkontrol, sindroma refeeding, jejunostomi,
penggunaan intubasi
II. CYCLIC TUBE FEEDINGS :
Pemberian melalui pompa dalam periode waktu tertentu
Direkomendasikan untuk pasien dengan pipa jejunal
III. INTERMITTENT GRAVITY DRIP :
Pemberian 240-270 ml selama 20-60 mnt
Digunakan pada pasien dengan pengosongan lambung lambat Aspirasi
IV. BOLUS TUBE FEEDINGS :
Pemberian 240-480 ml selama 10-20 mnt
Pasien dengan dukungan nutrisi yang lama dan regimen formula tetap
NP :
VENA PERIFER
< 600-900
mOsm/liter
KH dan
protein Tidak restriksi
konsentrasi cairan
kecil
5 -7 hari.
VENA Tersedia vena
PERIFER yang adekuat
Rule of Thumb
Calorie Requirement = 25 to 30 kcal/kg/day
Females
Height in cm = (1.35 x demispan in cm) + 60.1
Males HIckson M, Frost G. A comparison of three
methods for estimating height in the acutely ill
Height in cm = (1.40 x demispan in cm) + 57.8 elderly population. J Hum Nutr Diet. 2003;6:1-3
5. TIMING PEMBERIAN NUTRISI
STRESS RESPONSES
START
OPTIMAL
Enteral nutrition in the intervention group was started within 24-48 hours of admission/resuscitation.
Early vs. Delayed Supplemental Parenteral Nutrition
Canadian Clinical Practice Guidelines. March 2013
Conclusions:
1. Early vs late PN to supplement EN has no effect on mortality in critically
ill patients.
2. Early supplemental PN is associated with an increase in infectious
complications in critically ill patients compared to late supplemental PN.
3. Early supplemental PN is associated with significantly longer ICU and
hospital length of stay in critically ill patients compared to late
supplemental PN.
4. Early supplemental PN is associated with an increase in duration of
ventilation in critically ill patients compared to late supplemental PN.
Conclusions
Late-initiation of PN was associated with Faster Recovery
and Fewer Complications, when compared with early
initiation.
Intentional Underfeeding: TROPHIC FEEDS VS FULL FEEDS
Canadian Clinical Practice Guidelines. March 2013
Conclusions:
1. The use of trophic vs full feeds has no effect on mortality in
critically ill patients
2. The use of trophic vs full feeds has no effect on VAP in critically ill
patients
3. The use of trophic vs full feeds may be associated with significant
underfeeding but better gastrointestinal tolerance in critically ill
patients.
6. KOMPOSISI
KEBUTUHAN ZAT GIZI MAKRO
Strategies To Minimize
Interruptions In Enteral Nutrition
Fowler