Hubungan tipe pemberian nutrisi dengan luaran pasien dan lama rawat pasien acute respiratory distress syndrome yang dirawat di unit perawatan intensif anak rsup sanglah

Bagus Ngurah Mahakrishna; Dyah Kanya Wati; I Nyoman Budi Hartawan; Ida Bagus Gede Suparyatha

doi:10.15562/medicina.v51i1.387

Hubungan tipe pemberian nutrisi dengan luaran pasien dan lama rawat pasien acute respiratory distress syndrome yang dirawat di unit perawatan intensif anak rsup sanglah

Bagus Ngurah Mahakrishna ,

Dyah Kanya Wati ,

I Nyoman Budi Hartawan ,

Ida Bagus Gede Suparyatha ,

PDF |
DOI: https://doi.org/10.15562/medicina.v51i1.387 |
Published: 2020-01-10

Abstract

Introduction: Early enteral nutrition has been suggested to reduce hypercatabolic condition, reduce the activation and the release of inflammatory cytokines, also decrease hospital length of stay compared with parenteral nutrition. The aim of this research was to investigate the association between nutritional selection with outcome and length of stay patients with acute respiratory distress syndrome in Pediatric Intensive Care Unit (PICU) Sanglah Hospital.

Method: It was a prospective cohort study by involving 60 patients with ARDS in PICU Sanglah Hospital. We studied characteristics and outcomes of 2 groups of patients: those who received early enteral nutrition, and parenteral nutrition. Outcomes of interest were mortality, and length of stay.

Result: A total of 60 patients with ARDS were enrolled, with 29 patients received parenteral nutrition, and 31 patients received enteral nutrition. Total 29 patients who received parenteral nutrition <48 hours, 18 (62.1%) patients passed away, and survived 11 (37.9%), with 95% CI 2.444-37.873; p value=<0.001. Total 21 patients who received enteral nutrition <48 hours, 2 (6.5%) passed away and survived 29 (93.5%).

Conclusion: The incidence of mortality on parenteral nutrition was 9.6 times higher than enteral nutrition.

Pendahuluan: Pemberian nutrisi enteral pada pasien dengan ARDS yang lebih cepat dapat menurunkan kondisi hiperkatabolisme, mengurangi produksi sitokin pro-inflamasi, dan menurunkan durasi lama rawat pasien dibandingkan dengan pemberian nutrisi parenteral. Penelitian ini bertujuan untuk menilai hubungan tipe pemberian nutrisi dengan luaran pasien dan lama rawat pasien ARDS yang dirawat di UPIA RSUP Sanglah.

Bahan dan Metode: Penelitian ini menggunakan rancangan kohort prospektif dengan melibatkan 60 anak dengan ARDS yang dirawat di UPIA RSUP Sanglah. Subyek penelitian dibagi menjadi 2, yaitu kelompok yang mendapatkan nutrisi enteral dan nutrisi parenteral. Waktu pemberian nutrisi enteral dan parenteral dilihat <48 jam saat subyek terdiagnosis ARDS.

Hasil: Total 60 pasien ARDS diikutsertakan dalam penelitian, dengan 29 pasien mendapatkan nutrisi parenteral dan 31 pasien mendapatkan nutrisi enteral. Angka kematian pada kelompok yang mendapatkan nutrisi parenteral <48 jam sebesar 18 orang (62,1%) dan hidup 11 orang (37,9%), dengan IK 95% 2,444-37,873; nilai p=<0,001. Angka kematian pada kelompok yang mendapatkan nutrisi enteral <48 jam sebesar orang 2 (6,5%) dan hidup 29 orang (93,5%).

Kesimpulan: Angka kematian pada kelompok yang mendapatkan nutrisi parenteral 9,6 kali lebih tinggi dibandingkan kelompok yang mendapatkan nutrisi enteral.

References

Panico FF, Troster EJ, Oliviera CS, Faria A, Lucena M, Joao PR, dkk. Risk Factors for Mortality and Outcomes in Pediatric Acute Lung Injury/Acute Respiratory Distress Syndrome. Pediatr Crit Care Med. 2015;16:194-200.
Rotta AT, Piva JP, Andreolio C, de Carvalho WB, Celiny P, Garcia R. Progress and perspectives in pediatric acute respiratory distress syndrome. Rev Bras Ter Intensiva. 2015;27:266-73.
Tsuhima K, King LS, Aggarwal NR, De Gorordo, Dâ€™Alessio FR, Kubo K. Acute lung injury review. Intern Med. 2009;48:621-30.
Raniere VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, dkk. Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012;307:2526-33.
Erickson S, Schibler A, Numa A, Nutall G, Yung M, dkk. Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observa- tional study. Pediatr Crit Care Med. 2007;8:317-23.
Bindl L, Dresbach K, Lentze MJ. Incidence of acute respiratory distress syndrome in German children and adolescents: a population-based study. Crit Care Med. 2005;33:209-12.
Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD. Incidence and Outcomes of Pediatric Acute Lung Injury. Pediatrics. 2009;12:87-95.
Saharan S, Lodha R, Kabra SK. Management of acute lung injury/ARDS. Indian J Pediatr. 2010;77:1296-302.
Krzak A, Pleva M, Napolitano LM. Nutrition therapy for ALI and ARDS. Crit Care Clin. 2011;27:647-59.
Wong JJ, Han WM, Sultana R, Loh TF, Lee JH. Nutrition Delivery Outcomes in Pediatric Acute Respiratory Distress Syndrome. J Parenter Enteral Nutr. 2016.
Gomez IJA, Gonzalez CB, Palacio PAM, Santis ETM, Bayona JDT, Hernandez JPC, dkk. Nutritional Support of the Critically Ill Pediatric Patient: Foundations and Controversies. Clinical Medicine Insights: Trauma and Intensive Medicine. 2017;8:1-7.
Zamberlan P, Delgado AF, Leone C, Feferbaum R, Okay TS. Nutrition therapy in a pediatric intensive care unit: indica- tions, monitoring, and complications. J Parenter Enteral Nutr. 2011;35:523-29.
Bauer PR, Gajic O, Hubmayr RD. Early nutritional support is associated with improved improved outcomes in respi- ratory failure. Acta Medica Academica. 2010;39:14-20.
Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meydrofit G, dkk. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365:506-17.
Fivez T, Kerklaan D, Mesotten D, Verbruggen S, Wouters PJ, Vanhorebeek I, dkk. Early versus late parenteral nutrition in critically ill children. N Engl J Med. 2016;374:1111-22.