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Monique Carolina Widjaja
Tatalaksana nutrisi pada luka bakar berat = Nutritional therapy in severe burns
"Luka bakar berat berhubungan dengan tingginya angka morbiditas dan mortalitas. Tatalaksana nutrisi pada luka bakar berat diutamakan pada pemberian nutrisi enteral dini (NED). Nutrisi enteral dini diberikan sedini mungkin setelah resusitasi tercapai, bermanfaat sebagai trophic feeding yang terbukti mencegah terjadinya atrofi vili-vili mukosa sebagai upaya mengatasi dampak hipoperfusi splangnikus. Pemberian nutrisi ditingkatkan bertahap sesuai asupan, toleransi, dan keadaan klinis pasien. Serial kasus ini terdiri dari tiga kasus dengan penyebab api dan satu yang disebabkan oleh listrik. Dua kasus dengan trauma inhalasi dan dua kasus dengan kegagalan ginjal akut (AKI). Dua kasus masuk pada hari pertama pasca trauma, dan dua kasus pada hari ke enam dan delapan pasca trauma. Keempat kasus masih dalam keadaan resusitasi cairan, sehingga pemberian nutrisi ditujukan untuk pemberian NED. Monitoring dilakukan pada klinis, asupan dan toleransi, dan laboratorium terutama darah perifer lengkap, elektrolit, analisis gas darah, laktat, albumin, dan fungsi ginjal.
Asupan keempat kasus tidak pernah mencapai total karena berulang kali dipuasakan untuk pembedahan. Aliran balik yang tinggi menunjukkan intoleransi saluran cerna sehingga perlu diberikan prokinetik. Pemberian antibiotik sebagai suatu kebutuhan mutlak perlu memperhatikan interaksinya dengan nutrien. Pemberian analgetika dan sedatif perlu memperhatikan interaksi dan efek terhadap kebutuhan nutrisi. Trombositopenia yang terjadi pada tiga kasus berhubungan dengan sepsis dan mortalitas. Koagulopati bersama dengan hipotermia dan asidosis menjadi komponen Triad of Death. Hiperlaktatemia harus dinilai bersamaan dengan parameter lain untuk menilai adanya hipoksia jaringan. Dua kasus berkomplikasi menjadi AKI, tatalaksana nutrisi memperhatikan terapi yang didapat pasien. Pemberian medikamentosa untuk perbaikan sirkulasi juga memperhatikan interaksi obat.
Severe burns associated with high morbidity and mortality. Nutritional management of severe burns priority on early enteral nutrition (EEN). Early enteral nutrition is given as early as possible after resuscitation achieved, useful as trophic feeding are proven to prevent the occurrence of mucosal villous atrophy as the effort to overcome the effects of splanchnic hypoperfusion. Providing appropriate nutrition intake gradually increased, due to tolerance, and clinical condition of patients. This case series consisted of three cases the cause of the fire and one caused by electricity. Two cases with inhalation injury and two cases with acute renal failure (ARF). Two cases admitted on the first day after trauma, and two cases in the sixth and eighth days after trauma. The four cases are still in a state of fluid resuscitation, thus giving nutrition aimed at giving EEN. Monitoring conducted in clinical condition, caloric intake and tolerance, and laboratories especially equipped peripheral blood, electrolytes, blood gases analysis, lactate, albumin, and kidney function.
Intake of four cases never reach the total due to repeated fasting for surgery. High-flow indicates that gastrointestinal intolerance should be given prokinetic agent. Giving antibiotics as an absolute necessity need to consider interactions with nutrients. Giving analgesics and sedatives need to consider interactions and effects on nutritional requirements. Thrombocytopenia occurred in three cases and mortality associated with sepsis. Coagulopathy with hypothermia and acidosis become components Triad of Death. Hyperlactatemia should be assessed in conjunction with other parameters to assess the presence of tissue hypoxia. Two cases complicated to AKI, nutritional management of patients gained attention therapy. Giving drug therapy for improved circulation also consider drug interactions."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2012
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UI - Tugas Akhir  Universitas Indonesia Library
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Lily Indriani Octovia
Tatalaksana nutrisi pasien luka bakar berat dengan trauma inhalasi dan sepsis = Nutritional support in severe burns with inhalation injury and sepsis
"Latar belakang: luka bakar berat dapat disertai dengan trauma inhalasi, yang akan memicu respons lokal dan sistemik, sehingga menyebabkan berbagai komplikasi, termasuk systemic inflammatory response syndrome (SIRS) dan sepsis. Berbagai kondisi ini menyebabkan hipermetabolime dan hiperkatabolisme, yang membutuhkan tatalaksana nutrisi adekuat untuk membantu proses penyembuhan pasien. Berbagai kelompok ahli telah memberikan rekomendasi tatalaksana nutrisi pada luka bakar berat dan sakit kritis. Namun, akibat keterbatasan sarana dan prasarana, tidak semua rekomendasi dapat dilaksanakan, sehingga tatalaksana nutrisi diberikan secara optimal. Metode: serial kasus ini terdiri atas empat pasien luka bakar berat, yang disebabkan oleh api, dan disertai trauma inhalasi, yang menyebabkan berbagai komplikasi, sepsis, multiple organ dysfunction syndrome (MODS) dan multiple organ failure (MOF). Tatalaksana nutrisi diberikan secara bertahap sesuai dengan keadaan pasien. Pemberian nutrisi diawali dengan nutrisi enteral dini (NED) dalam waktu 2448 jam setelah luka bakar, sebesar 10 kkal/kg BB, menggunakan drip intermiten. Selanjutnya, nutrisi diberikan sebesar 2025 kkal/kg BB pada fase akut dan 2530 kkal/kg BB/hari pada fase anabolik. Setelah pasien keluar dari intensive care unit (ICU), target kebutuhan energi menggunakan persamaan Xie, dengan protein 1,52,0 g/kg BB/hari, lemak 2530%, dan karbohidrat (KH) 5565%. Mikronutrien diberikan berupa multivitamin antioksidan, vitamin B, asam folat, dan vitamin D. Pasien dalam serial kasus ini juga mendapatkan nutrisi spesifik glutamin sebesar 0,3 g/kg BB/hari, selama 510 hari. Hasil: tiga pasien mengalami perbaikan klinis, kapasitas fungsional, dan laboratorium. Pasien selamat dan dipulangkan untuk rawat jalan. Masa rawat pasien yang selamat berturut-turut 33 hari, 70 hari, dan 43 hari. Seorang pasien mengalami perburukan dan MOF, hingga meninggal dunia setelah dirawat selama 23 hari di ICU. Kesimpulan: tatalaksana nutrisi optimal dapat menunjang penyembuhan luka serta menurunkan angka morbiditas dan mortalitas pasien luka bakar berat dengan trauma inhalasi dan sepsis.
;Background: severe burn trauma combined with inhalation injury initiates local and systemic response, resulting in various complications such as systemic inflammatory response syndrome (SIRS) and sepsis. These conditions stimulate hypercatabolic process, leading to the increase of nutrition requirement. Adequate nutritional support is necessary in order to control both inflammatory and metabolic response, and also to improve healing process. To date, nutritional recommendations specific for severe burn trauma and critical illness have been established. However, many problems including patient?s condition and lack of resources exist, so optimal nutritional support that fits our settings was delivered. Method: this serial case focused on four severely burned patients caused by flame. Subjects with inhalation trauma and complications such as sepsis, multiple organ dysfunction syndrome (MODS), and multiple organ failure (MOF) were included in this study. Nutritional support was delivered according to clinical conditions, patient?s tolerance, and laboratory findings. Early enteral nutrition was initiated within 2448 hours post burns, starting from 10 kcal/kg BW/day with intermittent gravity drip method. Nutrition was gradually increased in order to reach the target of energy for critically ill patients, which is 2025 kcal/kg BW/day in acute phase or 2530 kcal/kg BW/day in anabolic recovery phase. Xie Equation was used to calculate target of total energy for burned patient. Protein requirement was 1.52.0 g/kg BW/day. Lipid and carbohydrate given were 2530% and 5565% from calorie intake, respectively. Micronutrient supplementation including antioxidants, vitamin B, folic acid, and vitamin D was also provided. Glutamin as specific nutrient was delivered by 0.3 g/kg BW/day in 510 days. Results: improvement of clinical condition, functional capacity, and laboratory parameters was observed in three patients, who could be discharged from hospital and asked to come back for outpatient care. Their lengths of stay were 33 days, 70 days, and 43 days, respectively. However, one patient experienced worsening of condition and died after 22 days of care in Intensive Care Unit (ICU). Conclusions: optimal nutritional support for severely burned patients with inhalation trauma and sepsis is necessary in order to improve healing process, as well as decrease morbidity and mortality."
Depok: Fakultas Kedokteran Universitas Indonesia, 2016
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UI - Tugas Akhir  Universitas Indonesia Library
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Eva Kurniawati
Tatalaksana nutrisi pasien luka bakar berat = Nutritional management in severe burned patients
"Pasien pada serial kasus ini adalah empat pasien dewasa dengan luka bakar berat, masuk perawatan dalam kondisi resusitasi. Status nutrisi sebelum sakit adalah overweight dan satu pasien normoweight. Inisiasi nutrisi enteral dilakukan 15-39,5 jam pasca kejadian. Pemberian nutrisi dimulai dari hipokalori (<20 Kkal/kgBB/hari), ditingkatkan bertahap menuju kebutuhan energi total yang dihitung berdasarkan formula Xie dengan berat badan sebelum sakit. Selama perawatan di ICU, pasien mencapai kalori sebesar 60-96% KET, protein sebesar 0,6-1,9 g/kgBB/hari, komposisi lemak dan karbohidrat berturut-turut sebesar 15-25%, dan 50-64%. Jalur pemberian nutrisi parenteral dengan central venous cathether (CVC) sedangkan enteral dengan nasogastric tube (NGT) tetes lambat secara intermiten. Mikronutrien yang diberikan berupa multivitamin antioksidan, vitamin B kompleks dan asam folat. Pemantauan terapi nutrisi meliputi tanda klinis, toleransi asupan makanan, kapasitas fungsional, imbang cairan, parameter laboratorium dan antropometri. Pada kelompok survivor diberikan edukasi nutrisi terkait penyembuhan luka dan preservasi massa otot.
Patients in the case report were four adult patients with severe burns and admitted to the hospital under resuscitation conditions. Three patients were overweight and one was normoweight Enteral nutrition was initiated within 15–39.5 hours post injury. Nutrition administration began from hypocalory (<20 kcal/kg/day), then increased gradually to the total energy requirement using Xie formula based on the pre-illness weight. In the ICU, energy intake achieved 60-96% of total requirement, protein was 0.6 to 1.9 g/kgBW/day, fat, and carbohydrate were 15-25% and 50-64% respectively. Parenteral nutrition was given via central venous cathether while enteral nutrition was dripped intermittently. Micronutrients were given as multivitamin antioxidants, vitamin B complex, and folic acid. The survivors were given nutrition education related to wound healing and preservation of muscle mass."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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UI - Tugas Akhir  Universitas Indonesia Library
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Sophika Umaya
Terapi Medik Gizi pada Pasien Luka Bakar Berat dengan Diabetes Melitus Tipe 2 = Medical Nutritional Therapy in Severe Burns Patients with Type 2 Diabetes Mellitus.
"Latar Belakang: Luka bakar berat dengan komorbid diabetes melitus (DM) secara teoritis dapat mengalami fenomena second hit, rentan terhadap peningkatan respon hipermetabolisme karena efek gabungan luka bakar akut dan patofisiologi DM. Implikasi gabungan efek tersebut meningkatkan morbiditas mortalitas, sehingga dibutuhkan tatalaksana nutrisi adekuat untuk melawan respon hipermetabolik dan hiperkatabolik, yang diharapkan memengaruhi perbaikan kontrol glukosa darah.
Metode: Serial kasus ini terdiri atas empat pasien luka bakar berat karena api dengan DM tipe 2 yang dirawat di ICU luka bakar. Tatalaksana nutrisi diberikan dengan nutrisi enteral dini dalam waktu 24 jam pertama, secara bertahap diberikan sesuai kondisi klinis dan toleransi asupan, dengan target kebutuhan energi awal 20-25 kkal/kg BB/hari, protein 1,5-2 g/kg BB/hari, lemak 25-30%, dan karbohidrat 55-60%.
Hasil: Pemberian nutrisi pada keempat pasien dapat membantu mempertahankan kadar glukosa darah tidak mengalami peningkatan fluktuasi tajam. Interupsi pemberian nutrisi yang disebabkan berbagai kondisi klinis dan tindakan, menyebabkan target energi dan protein harian sulit tercapai pada keempat pasien. Komplikasi sepsis dan syok sepsis terjadi sehingga pada akhirnya keempat pasien meninggal.
Kesimpulan: Luka bakar berat, pengendalian infeksi, obesitas, komorbid DM, variabilitas glikemik, serta tatalaksana nutrisi yang tidak adekuat, dapat meningkatkan morbiditas mortalitas pada pasien ini, karenanya masih menjadi tantangan tim terapi medik gizi.
Background: Severe burns with comorbid diabetes mellitus (DM) can theoretically experience a second hit phenomenon, susceptible to increased hypermetabolic response due to the combined effect of acute burns and DM pathophysiology. The combined implications of these effects increase mortality morbidity, so that adequate management of nutrition is needed to counteract the hypermetabolic and hypercatabolic responses, which are expected to influence improvement in blood glucose control.
Method: The cases series consist of four patients with severe burns due to fire with type 2 DM, treated in ICU burns. Nutritional management is given with early enteral nutrition in the first 24 hours, gradually given according to clinical conditions and intake tolerance, with a target of initial energy requirements of 20-25 kcal/kg body weight/day, protein 1.5-2 g/kg body weight/day, 25-30% fat, and carbohydrates 55-60%.
Results: Nutrition therapy to all four patients can help maintain blood glucose levels not experiencing sharp fluctuations. Nutritional interruption caused by various clinical conditions and actions, causes daily energy and protein targets difficult to achieve in all four patients. Complications of sepsis and sepsis shock occur and eventually all four patients die.
Conclusions: Severe burns, infection control, obesity, comorbid DM, glycemic variability, and inadequate nutritional management, can increase mortality morbidity in these patients, therefore it remains a challenge for the nutritional medical therapy team."
Depok: Fakultas Kedokteran Universitas Indonesia, 2019
T58657
UI - Tesis Membership  Universitas Indonesia Library
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Fenny
Terapi medik gizi pada pasien luka bakar berat: peran pemberian vitamin D = Medical nutritional therapy in severe burns patients: role of vitamin D supplementation
"Latar Belakang: Pada luka bakar terjadi peningkatan respon inflamasi. Peningkatan c-reactive protein (CRP) pada luka bakar merupakan penanda inflamasi sistemik. Kadar vitamin D yang rendah banyak ditemukan pada pasien luka bakar dan berhubungan dengan luaran klinis yang buruk. Vitamin D memiliki efek memodulasi imun dan antiinflamasi. Metode: Serial kasus ini terdiri dari 4 pasien luka bakar berat karena ledakan gas dan api yang dirawat di ULB pada periode Januari hingga Mei 2022. Terapi medik gizi yang diberikan berupa nutrisi enteral dini, kemudian ditingkatkan secara bertahap sesuai toleransi dan klinis pasien, hingga kebutuhan energi total (berdasarkan formula Xie), target protein 1,5-2 g/kg BB/hari, lemak 25-30%, dan karbohidrat 55-60%. Keempat pasien serial kasus diberikan suplementasi vitamin D dan dilakukan pemeriksaan kadar vitamin D sebelum dan sesudah suplementasi, serta pemeriksaan kadar CRP. Hasil: Keempat pasien serial kasus selama perawatan telah mencapai kebutuhan makronutrien sesuai target, meskipun terdapat fluktuasi asupan karena adanya perburukan kondisi klinis atau tindakan operasi/perawatan luka. Keempat pasien serial kasus memiliki kadar vitamin D yang rendah, namun mengalami peningkatan dengan suplementasi. Kadar CRP juga diperoleh meningkat dan mengalami penurunan dengan meningkatnya kadar vitamin D, yang menyebabkan hambatan produksi sitokin proinflamasi dan jalur NF-kB, selain adanya terapi pembedahan dan antibiotik. Keempat pasien serial kasus diperbolehkan rawat jalan pada akhir perawatan. Kesimpulan: Pada serial kasus ini, semua pasien luka bakar dengan kadar vitamin D yang rendah memiliki kondisi inflamasi yang tinggi ditandai dengan peningkatan CRP. Pemberian suplementasi vitamin D menyebabkan peningkatan kadar vitamin D dan turut berperan dalam penurunan CRP, selain adanya terapi pembedahan dan antibiotik
Background: Burns induce an increased inflammatory response. Elevated c-reactive protein (CRP) is a marker of systemic inflammation in burns. Low vitamin D levels are common in burn patients and are associated with poor clinical outcomes. Vitamin D has immune-modulating and anti-inflammatory effects. Method: The case series was held in the burn unit Dr. Cipto Mangunkusumo Hospital from January to May 2022, involving 4 severe burn patients due to gas explosions and fire. Nutritional medical therapy was given in the form of early enteral nutrition, then gradually increased according to patient tolerance and clinical, up to total energy requirements (based on Xie's formula), the target protein is 1.5-2 g/kg BW/day, 25-30% fat and 55-60% carbohydrates. Vitamin D supplementation was given and vitamin D levels were measured before and after supplementation, CRP levels were also measured. Result: All case series patients during treatment had achieved the target macronutrient requirements, despite fluctuations of intake due to clinical deterioration or surgical procedure or wound care. All patients had low vitamin D levels but increased with supplementation. CRP levels also increased and decreased with increasing vitamin D levels, leading to inhibition of inflammatory cytokines production and the NF-kB pathway, besides surgical and antibiotics therapy. All patients were allowed outpatient treatment at the end of treatment. Conclusion: This case series exhibited low level of vitamin D in burn patients accompanied with elevated CRP level indicating high inflammatory condition. Vitamin D supplementation causes an increase in vitamin D levels and may contribute to decreasing CRP levels, in addition to surgical and antibiotic therapy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Diana Felicia Suganda
Tatalaksana nutrisi penyakit kritis pada anak dengan pneumonia berat = Nutritional management in critically ill children with severe pneumonia
"Tatalaksana nutrisi penyakit kritis pada anak dengan pneumonia berat mencakup pemberian makronutrien, mikronutrien, nutrien spesifik, manajemen cairan dan elektrolit serta monitoring status gizi. Terapi nutrisi yang adekuat harus diberikan pada anak sakit kritis yang dirawat intensif dengan tujuan meminimalkan efek fase akut. Sekitar 15-20% anak masuk perawatan intensif sudah dalam kondisi malnutrisi sebelumnya. Malnutrisi sering terjadi pada pasien dengan penyakit paru. Status nutrisi yang terganggu dapat mempengaruhi fungsi paru pada pasien yang bernapas spontan maupun yang menggunakan ventilator, karena status nutrisi dapat mempengaruhi fungsi otot pernapasan, kemampuan ventilasi, respon terhadap hipoksia dan mekanisme pertahanan paru. Pasien pada serial kasus ini mempunyai rentang usia 3-4,5 bulan. Umumnya keluhan utama adalah sesak napas yang semakin berat, disertai dengan tarikan dinding dada dan malas menyusu. Berkurangnya asupan menyebabkan pasien mengalami masalah gizi sehingga perlu adanya dukungan nutrisi. Terapi nutrisi diberikan sesuai dengan kebutuhan masing-masing pasien, yang dihitung dengan rumus Schofield atau rumus White jika menggunakan ventilator, kemudian dikalikan faktor stres dan pemberiannya dimulai dari 80% kebutuhan energi basal, yang secara bertahap ditingkatkan hingga mencapai kebutuhan total. Kebutuhan protein dan lemak disesuaikan dengan kondisi sakit kritis. Pemantauan terapi nutrisi dilakukan pada delapan hingga sebelas hari. Pemantauan mencakup tanda klinis, toleransi asupan makanan, kapasitas fungsional, balans cairan, parameter laboratorium dan antropometri. Selama pemantauan didapatkan bahwa sebagian besar pasien dapat mencapai kebutuhan energi total pada hari keenam hingga delapan pemantauan. Pemberian nutrisi pada pasien sakit kritis bersifat individual dan mencakup semua aspek. Dengan tatalaksana nutrisi yang baik, diharapkan kualitas hidup pasien pneumonia berat dengan berbagai penyakit penyerta akan lebih baik.
Nutrition therapy in critically ill children with severe pneumonia includes the provision of macronutrient, micronutrient, specific nutrition, fluid and electrolyte management and nutrition status monitoring. Adequate nutrition therapy should be given in critically ill children in the intensive care to minimize acute phase effect. Approximately 15-20% children admitted to the intensive care already in malnutrition state. Malnutrition is common in patients with pulmonary disease. Altered nutrition status can effect pulmonary function in spontaneous breathing or in mechanically ventilator dependent patient, because nutritional status can affect muscle function, ventilatory drive, hypoxia response and pulmonary defense mechanism. Patients in this case series have an age range from 3 to 4.5 months. Their chief complaints were dyspnoe (difficulty in breathing) with chest retraction and lack of breastfeed. Reduce intake caused patient prone to nutritional problem. Nutritional support is given according to each patient’s requirement, which is calculated with Schofield equation or White equation if the patient on ventilator, using stress factor and the administration starts with 80% basal energy expenditure, which gradually increased to reach the total energy expenditure. Protein and lipid requirement is calculated based on critically ill state. Patient’s monitoring performed on eight to eleven days. Patient’s clinical signs, food intake tolerance, functional capacity, fluid balance, laboratory and anthropometric parameter were taken. During the monitoring it was found that most patients can achieve total energy requirement on day six to eight monitoring. Nutrition in critically ill patients is individualized and includes all aspects. With the management of good nutrition, expected quality of life of patients with severe pneumonia various comorbidities would be better."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tugas Akhir  Universitas Indonesia Library
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Steffi Sonia
Terapi medik gizi klinik pada pasien anak dengan luka bakar = Nutritional therapy in pediatric patients with burns
"Luka bakar adalah bentuk trauma yang paling berat yang menyebabkan hipermetabolisme berkepanjangan. Jika asupan nutrisi tidak adekuat, penurunan berat badan dapat terjadi, yang kemudian akan memengaruhi pertumbuhan, penyembuhan luka, dan imunitas. Pedoman nutrisi pada anak dengan luka bakar dibuat di negara maju, sehingga mungkin akan sulit diterapkan di negara berkembang. Pada serial kasus ini, terapi nutrisi diberikan kepada empat pasien anak pasca luka bakar dengan usia 2 ndash;8 tahun dan luas luka bakar antara 5 dan 35 total body surface area. Dari keempat pasien tersebut terdapat satu pasien dengan luka bakar mayor. Target kebutuhan energi ditentukan dengan menggunakan rumus Schofield ditambah faktor stres 1,5 ndash;2 menurut luas luka bakar pasien. Target protein ditetapkan sebesar 1,5 ndash;3 g/kg/hari menurut luas luka bakar pasien. Semua pasien mendapatkan nutrisi melalui jalur oral, dengan jumlah yang ditingkatkan secara bertahap hingga mencapai target. Suplementasi mikronutrien diberikan kepada semua pasien mendekati rekomendasi, namun suplementasi tembaga tidak diberikan karena keterbatasan sediaan. Terdapat penurunan berat badan pada dua pasien, namun status gizi yang baik berhasil dipertahankan pada semua pasien. Semua pasien juga mengalami penyembuhan luka yang progresif. Terapi medik gizi klinik pada pasien anak dengan luka bakar dapat mempertahankan status gizi yang baik dan membantu penyembuhan luka.
Burn injury is the most severe trauma that causes prolonged hypermetabolism. Inadequate nutritional intake may cause weight loss, which in turn may influence growth, wound healing, and immunity. Nutritional guidelines for pediatric burn were made in developed countries, meanwhile their application in a developing country may be limitted. In this case series, nutritional therapy was instituted on four pediatric burn patients aged 2 ndash 8 years old with burn surface areas between 5 and 35 total body surface area. Among these patients, there was one patient with major burn. Energy requirements were determined using Schofield formula and stress factors of 1,5 ndash 2 depending on the patient rsquo s burn surface area. Protein requirements were set at 1,5 ndash 3 g kg day depending on the patient rsquo s burn surface area. All patients were given oral nutrition, with stepwise increases until the goals were achieved. Micronutrient supplementation was given to all patients according to previous recommendations, however copper supplementation was not be given due to unavailability. Two patients experienced weight loss, but normal nutritional status was maintained in all patients. In addition, progressive wound healing was observed in all patients. In conclusion, nutritional therapy in pediatric burn patients may preserve normal nutritional status and promote wound healing."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Endang Widyastuti
Terapi nutrisi gizi pasien luka bakar berat dengan disfungsi pernapasan = Nutritional therapy of burn patients with respiratory dysfunction
"ABSTRAK
Latar belakang: Luka bakar merupakan suatu trauma yang dapat memicu respons inflamasi lokal dan sistemik sehingga menimbulkan komplikasi berbagai organ, diantaranya disfungsi pernapasan. Hipermetabolisme, hiperkatabolisme, dan adanya disfungsi pernapasan yang terjadi, memerlukan tatalaksana nutrisi adekuat untuk menurunkan respons inflamasi, mencegah peningkatan produksi CO2, mencegah wasting otot dan meningkatkan imunitas Metode: Empat pasien dalam serial kasus ini mengalami luka bakar berat karena api, dirawat di ruang perawatan intensive care unit ICU unit luka bakar rumah sakit Cipto mangunkusumo RSCM dan menggunakan alat bantu ventilasi mekanik. Target energi menggunakan metode Xie dan Harris-Benedict dengan berat badan sebelum sakit. Pemberian nutrisi diberikan sesuai dengan rekomendasi untuk sakit kritis fase akut 20 ndash;25 kkal/kg BB dengan komposisi karbohidrat 55-65 , Protein 1,5-2 g/kgBB, lemak
ABSTRACT Background Burn injury is a trauma that can trigger local and systemic inflammatory response, resulting complications of various organs, including respiratory dysfunction. Hipermetabolism, hypercatabolism, and the presence of respiratory dysfunction that occurs, require adequate nutritional management to decrease inflammatory responses, prevent increased CO2 production, prevent muscle wasting and enhance immunity. Method Four patients in this series of cases suffered severe burns from fire, were treated in the intensive care unit ICU hospital burning unit Cipto mangunkusumo hospital RSCM and used mechanical ventilation aids. Energy targets use Xie and Harris Benedict methods with weight loss before illness. Nutrition was given in accordance with recommendations for acute phase critical pain 20 25 kcal kg BW with carbohydrate composition 55 65 , 1.5 2 g kgBB protein, fat "
2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Pande Putu Agus Mahendra
Tatalaksana nutrisi pasien obes dengan luka bakar berat, sepsis dan trauma inhalasi = Nutritional management in severely burned among obese patients with sepsis and inhalation trauma
"ABSTRAK
Latar belakang: Luka bakar merupakan suatu trauma yang menyebabkan kerusakan dan kehilangan jaringan karena kontak dengan objek bersuhu tinggi. Kondisi tersebut memicu respons inflamasi lokal dan sistemik yang memicu komplikasi. Hipermetabolisme dan hiperkatabolisme yang terjadi memerlukan tatalaksana nutrisi adekuat untuk menurunkan respons inflamasi, mencegah wasting otot, meningkatkan imunitas, dan mempercepat penyembuhan luka.
Metode: Empat pasien dalam serial kasus ini mengalami luka bakar berat karena api dengan berbagai pencetus. Dua pasien dalam serial kasus ini masuk perawatan lebih dari 24 jam pasca kejadian. Status nutrisi pasien obes derajat II 1 pasien dan obes derajat I 3 pasien . Target energi menggunakan metode Xie dan Harris ndash;Benedict dengan berat badan sebelum sakit. Pemberian nutrisi diberikan sesuai dengan rekomendasi untuk sakit kritis fase akut 20 ndash;25 kkal/kg BB. Nutrisi dini dilakukan pada dua pasien yang datang kurang dari 24 jam pasca kejadian. Nutrisi diberikan melalui jalur enteral dengan metode drip intermittent. Tatalaksana nutrisi selanjutnya disesuaikan dengan toleransi dan kondisi klinis yang dialami pasien.
Hasil: Tiga pasien meninggal selama perawatan karena komplikasi sepsis Tatalaksana nutrisi dinaikkan bertahap sesuai kondisi klinis pasien. Pasien kasus keempat mengalami perbaikan dengan luas luka bakar 48,5 menjadi 11,5 dan peningkatan kapasitas fungsional, walaupun terjadi penurunan berat badan hingga 12 kg selama perawatan.
Kesimpulan: Tatalaksana nutrisi yang adekuat dengan memperhatikan kondisi klinis serta parameter penunjang lainnya dapat menunjang proses penyembuhan luka serta menurunkan laju morbiditas dan mortalitas pada pasien luka bakar. Kata kunci: luka bakar berat, tatalaksana nutrisi.
ABSTRACT
Background Burn injury is a trauma that caused damage and tissue loss due to contact with high temperature objects. That conditions will initiated local and systemic inflammatory reaction, which trigger complications after burn injury. Adequate nutrition management is needed in hypermetabolic and hypercatabolic condition to decrease the inflammatory response, prevents muscle wasting, improve immunity and wound healing.
Methods Four patients in this case series suffered from burn injury by fire with various origins. Two patients in this case series were treated more than 24 hours after trauma. Patients nutritional status were obese grade II 1 patient and grade I 3 patients. Energy requirement was measured by using Xie and Harris Benedict equations, with usual body weight. Nutrition was given base on recommendation for critically ill in acute phase, 20 ndash 25 kcal kg BW. Enteral nutrition was initiated for two patients who came less than 24 hours post burn, using intermittent drip method. The nutrition was adjusted daily depend on their clinical condition.
Results Three patients died during treatments for septic complications. Nutrients management gradually increase in accordance to clinical conditions. Patient in 4th cases experienced improvement with burn area decreased from 48,5 to 11,5 , also increasing on functional capacity, despite of weight loss up to 12 kg during treatment.
Conclusion Adequate nutritional management based on clinical conditions not only to reduce morbidity and mortality in burn patients, but also lead to improve healing process.. Keywords severe burn, nutrition management."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
T55615
UI - Tugas Akhir  Universitas Indonesia Library
cover
Imelda Goretti
Tatalaksana nutrisi pasien luka bakar berat dengan berbagai penyulit = Nutrition management in severely burned patients with various complicating conditions
"[Latar belakang
: luka bakar akan memicu terjadinya respon inflamasi lokal dan
sistemik, yang dapat menimbulkan berbagai komplikasi. Pada pasien luka bakar,
terjadi peningkatan kebutuhan akan zat gizi akibat kondisi hipermetabolik dan
hiperkatabolik yang terjadi. Tatalak
sana nutrisi yang adekuat dibutuhkan untuk
membantu kontrol respon inflamasi dan metabolik sehingga dapat menunjang
penyembuhan pasien.
Metode: Dalam serial kasus ini terdapat empat pasien luka bakar berat yang
disebabkan api dan listrik. Selama perawatan didapatkan berbagai penyulit yang
mempe
ngaruhi tatalaksana nutrisi yang diberikan. Pada pasien pertama terdapat
trauma inhalasi, yang berkembang menjadi ARDS dan gagal nafas. Pada pasien
kedua terdapat sepsis, yang berkembang menjadi syok sepsis dan gagal organ
multipel. Pasien ketiga mengalami amputasi dan AKI, sedangkan pasien keempat
mengalami rabdomiolisis, AKI, dan amputasi. Target energi dihitung berdasarkan
formula Xie dan Harris Benedict, dengan target protein 1,7?2 g/kgBB, lemak 20?
25%
dan karbohidrat 60?65%. Nutrisi enteral dimulai dalam waktu 21?35 jam
pasca kejadian sebesar 13?
20 kkal/kg/hari dengan metode pemberian drip
intermittent. Pemberian nutrisi selanjutnya sesuaikan dengan toleransi, klinis, dan
penyulit yang dialami pasien. Mikronutrien yang diberikan berupa multivitamin
antioksidan, vitamin B, dan asam folat.
Hasil: dua pasien pertama meninggal dalam perawatan, namun pasien pertama
telah mengalami perbaikan luas luka bakar dari 54% menjadi 32,5%. Dua pasien
terakhir mengalami perbaikan kapasitas fungsional dan penyembuhan luka yang
baik.
Kesimpulan: Tatalaksana nutrisi yang tepat dan adekuat sesuai dengan kondisi klinis pasien dapat menunjang penyembuhan serta menurunkan morbiditas dan mortalitas pasien.;Background: Burn injury initiates local dan systemic inflammatory reaction,
resulting various complicating conditions. Nutritional requirement after major
burn significantly increased because hypermetabolic and hypercatabolic
cond
ition. Effective and adequate nutrition therapy is required to control
inflammatory dan metabolic response, therefore enchance healing process.
Method: The current case series consists of four patients with severe burn injury
caused by flame and electricity. During hospitalization, complicating conditions
developed in all patients which influenced nutrition therapy given to the patients.
First patient had inhalation injury that developed into ARDS and respiratory
failure, while sepsis that progress to septic shock and MODS occured in second
patient. Third patient had amputation and AKI, while fourth patient experienced
rhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xie
and Harris-Benedict formula with target protein was 1,7?2 g/kgBB, lipid 20?25%,
a
nd carbohydrate 60?65%. Enteral nutrition was initiated within 21?35 hours post
burn, started at 13?20 Kcal/kg/day with intermintent gravity drip method. Further,
nutrition was given according to patients? tolerance, clinical condition, and
complicating conditions. Micronutients supplementation with antioxidant, vitamin
B, and folic acid were provided to all patients.
Result: The first two patients died during hospitalization, however, there was
improvement in first patient?s burn wound extent from 54% to 32,5% TBSA. The
last two patients had satisfactory wound healing and improvement in functional
capacity.
Conclusion: Effective and adequate nutrition management inline with patient?s clinical condition lead to enhacement healing process, and reduced morbidity and mortality rate.;Background: Burn injury initiates local dan systemic inflammatory reaction,
resulting various complicating conditions. Nutritional requirement after major
burn significantly increased because hypermetabolic and hypercatabolic
cond
ition. Effective and adequate nutrition therapy is required to control
inflammatory dan metabolic response, therefore enchance healing process.
Method: The current case series consists of four patients with severe burn injury
caused by flame and electricity. During hospitalization, complicating conditions
developed in all patients which influenced nutrition therapy given to the patients.
First patient had inhalation injury that developed into ARDS and respiratory
failure, while sepsis that progress to septic shock and MODS occured in second
patient. Third patient had amputation and AKI, while fourth patient experienced
rhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xie
and Harris-Benedict formula with target protein was 1,7?2 g/kgBB, lipid 20?25%,
a
nd carbohydrate 60?65%. Enteral nutrition was initiated within 21?35 hours post
burn, started at 13?20 Kcal/kg/day with intermintent gravity drip method. Further,
nutrition was given according to patients? tolerance, clinical condition, and
complicating conditions. Micronutients supplementation with antioxidant, vitamin
B, and folic acid were provided to all patients.
Result: The first two patients died during hospitalization, however, there was
improvement in first patient?s burn wound extent from 54% to 32,5% TBSA. The
last two patients had satisfactory wound healing and improvement in functional
capacity.
Conclusion: Effective and adequate nutrition management inline with patient?s clinical condition lead to enhacement healing process, and reduced morbidity and mortality rate., Background: Burn injury initiates local dan systemic inflammatory reaction,
resulting various complicating conditions. Nutritional requirement after major
burn significantly increased because hypermetabolic and hypercatabolic
cond
ition. Effective and adequate nutrition therapy is required to control
inflammatory dan metabolic response, therefore enchance healing process.
Method: The current case series consists of four patients with severe burn injury
caused by flame and electricity. During hospitalization, complicating conditions
developed in all patients which influenced nutrition therapy given to the patients.
First patient had inhalation injury that developed into ARDS and respiratory
failure, while sepsis that progress to septic shock and MODS occured in second
patient. Third patient had amputation and AKI, while fourth patient experienced
rhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xie
and Harris-Benedict formula with target protein was 1,7–2 g/kgBB, lipid 20–25%,
a
nd carbohydrate 60–65%. Enteral nutrition was initiated within 21–35 hours post
burn, started at 13–20 Kcal/kg/day with intermintent gravity drip method. Further,
nutrition was given according to patients’ tolerance, clinical condition, and
complicating conditions. Micronutients supplementation with antioxidant, vitamin
B, and folic acid were provided to all patients.
Result: The first two patients died during hospitalization, however, there was
improvement in first patient’s burn wound extent from 54% to 32,5% TBSA. The
last two patients had satisfactory wound healing and improvement in functional
capacity.
Conclusion: Effective and adequate nutrition management inline with patient’s clinical condition lead to enhacement healing process, and reduced morbidity and mortality rate.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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