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"Tujuan : Mengetahui pengaruh pemberian NED terhadap status protein penderita luka bakar derajat II, 20-60% dari luas permukaan tubuh (LPT) dan/atau derajat III ≥ 10% LPT usia 18-60 tahun.Tempat : Unit Luka Bakar RSUPNCMBahan dan Cara : Penelitian ini merupakan suatu uji klinik dengan randomisasi yang telah disetujui oleh panitia tetap penilai etik penelitian Fakultas Kedokteran Universitas Indonesia. Duapuluh subyek yang memenuhi kriteria penerimaan dan penolakan dibagi 2 kelompok secara randomisasi blok. Sepuluh subyek perlakuan diberi NED mulai ≤ 8 jam pasca luka bakar, sedangkan 10 subyek kontrol diberi nutrisi enteral/oral 24 jam pasca luka bakar. Pengamatan dilakukan selama 12 hari. Status protein ditetapkan dengan pemeriksaan albumin dan prealbumin serum serta nitrogen urea urin (NUU). Sampel darah untuk pemeriksaan albumin dan prealbumin diambil hari ke-l, 7, dan 12. Urin tampung 24 jam untuk pemeriksaan NUU diambil hari ke-3, 7 dan 12. Uji statistik yang digunakan adalah uji t untuk data berdistribusi normal dan uji Mann Whitney U untuk data berdistribusi tidak normal, batas kemaknaan yang digunakan sebesar 5%.Hasil : Penelitian ini menunjukkan pemberian NED tidak menunjukkan perbedaan bermakna terhadap status protein antara kelompok perlakuan dan kelompok kontrol, tetapi pada kelompok perlakuan didapatkan peningkatan kadar prealbumin dan gambaran penurunan kadar NUU yang lebih tajam.Kesimpulan : NED mempunyai kecenderungan dapat memperbaiki status protein walaupun belum dapat dibuktikan secara statistik.

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The Effect of Early Enteral Nutrition (EEN) on Protein Status in Burn Patients at Burn Unit Dr. Cipto Mangun Kusumo Hospital 1999-2000Objective: To know the effect of EEN on protein status in burn patients with 20-60% total body surface area (TBSA) of second degree burned, and/or ≥ 10% TBSA of third degree burned, age 18-60 years old subjects.

Place: Burn Unit Cipto Mangunkusumo Hospital Material and Methods

The study was a randomized clinical trial, which already certify by the ethical clearance research committee of the Faculty of Medicine University of Indonesia. Twenty subjects were selected by inclusion and exclusion criteria. The subjects were divided into two groups by block randomization. Ten subjects were given enteral nutrition started ≤ 8 hours post burn, while 10 control subjects were given enteral / oral nutrition 24 hours post burn. Observation was done for 12 days. Protein status was determined by the laboratory result of albumin and prealbumin serum and the level of urinary urea nitrogen (UUN). Blood samples for albumin and prealbumin serum were taken on the day 1st, 7th and 12th. Twenty four hours collected urines for UUN examination were taken on the day 3rd, 7th and 12th . Statistical analysis was performed with t-test for data with normal distribution and Mann Whitney U test for data which do not conform to a normal distribution. The level of significance was 5%.

Results: The results showed no significant difference between the two groups, except on day 12th the prealbumin level tends to increase and the UUN level tend to decrease in the study group.

Conclusion : The EEN tend to be able to increase the protein status although has not statistically proven yet."

"Tujuan : Mengetahui pengaruh pemberian nutrisi enteral tinggi protein pada status protein penderita stroke akutTempat : Ruang rawat IRNA B, bagian Neurologi Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Jakarta.Metodologi : Penelitian adalah suatu uji klinik paralel yang telah disetujui oleh panitia tetap penilai etik penelitian Fakultas Kedokteran Universitas Indonesia. Sebanyak 36 subyek penelitian stroke hemoragik dan iskemik akut yang memenuhi kriteria dibagi dalam dua kelompok secara randomisasi blok. Sebanyak 18 orang kelompok perlakuan mendapat nutrisi enteral tinggi protein (NETP), sedangkan 18 orang kelompok kontrol mendapat makanan cair racikan rumah sakit. Pengukuran berat badan dan tinggi badar dilakukan pada hari 1. Pemeriksaan albumin dan prealbumin serum dilakukan pada hari ke 1 dan Pemeriksaan NUU dan kreatinin urin dari urin tampung 24 jam pada hari 1, dan 7. Imbang nitrogen diperoleh dengan menghitung asupan nitrogen dan NUU 24 jam Uji statistik yang digunakan adalah uji t untuk data yang berdistribusi normal, dan uji Mann Whitney untuk data yang berdistribusi tidak normal. Batas kemaknaan yang digunakan sebesar 5%.Hasil : Pada kelompok perlakuan didapatkan sedikit peningkatan ni1ai prealbumin yang belum bermakna, yaitu 0,161 (0,104-0,303) menjadi 0,163 (0,043 0,276) g/L, sedangkan pada kelompok kontrol didapatkan penurunan yang bermakna yaitu 0,181 (0,093-0,267) menjadi 0,138 (0,066-0,280). Didapatkan penurunan nilai albumin pada kedua kelompok. Penurunan nilai albumin pada kelompok perlakuan lebih sedikit dibandingkan kontrol, masing-masing yaitu - 0,35 dan - 0,60 g/dL.Pemberia NETP dapat menurunkan ekskresi kreatinin urin secara bermakna, yaitu dari 1019 (300-1530) menjadi 791,50 (246-1524) mg/24 jam), tetapi belum memperbaiki NUU dari imbang nitrogenKesimpulan : Pemberian NETP pada pasien stroke akut cenderung dapat meningkatkan status protein, walaupun belum dapat dibuktikan secara statistik.

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Effects High Protein Enteral Nutrition on Protein Status in Acute Stroke PatientsObjective To investigate the effects of high protein enteral nutrition on protein status in acute stroke.

Location: IRNA B, Cipto Mangunkusumo General Hospital, Jakarta

Subjects and Methods : The study was a parallel clinical trial, which was alread} certified by the Ethical Clearance Research Committee of Faculty of Medicine Universit of Indonesia. Thirty six subjects with acute hemorhagic and ischemic stroke wen selected using certain criteria. The subjects were divided into two groups using blocs randomization. Eighteen subjects in treatment group received high protein entera nutrition (HPEN), and the control group received enteral hospital diet. Body weight an( height were assessed on the la day of admission. Albumin and prealbumin were assessed on day 1 and 7. Urinary urea nitrogen (UUN) and urinary creatinine were assessed on da: 1, 4, and 7 using 24-hour urine collection. Nitrogen balance was calculated b: substracting nitrogen intake with urinary urea nitrogen. Statistical analysis was performe+ using t-test for normal distributed and Mann Whitney test for not normal distributed data The level of significance was 5%.

Results : In the treatment group, there was a slingtly increased in prealbumin level, bi: not yet significantly : 0,161 (0,104-0,303) to 0,163 (0,043-0,276) g,/L, while in the contra group markedly decreased : 0,181 0,093-0,267) to 0,138 (0,066-0,280) gIL, The albumi level decreased in both groups. Albumin level in the trreatment group decreased less tha the control group, respectively - 0,35 (-1,20-0,60) and - 0,60 (-1,40-0,00). The HPE] decreased urinary creatinine excretion significantly : 1019 (307-15310) to 791,50 (24( 1524), however UUN and nitrogen balance did not show any improvement

Conclusion : HPEN tend to be able to increase the protein status although has ni statistically been proven yet."

"Penelitian ini dilakukan untuk mengetahui pengaruh pemberian nutrisi enteral tinggi protein pada status protein penderita stroke akut. Subjek penelitian dibagi 2 kelompok secara randomisasi blok, yaitu kelompok perlakuan mendapat nutrisi enteral tinggi protein (NETP) dan kelompok kontrol mendapat nutrisi enteral standar rumah sakit (NERS). Tiga puluh enam subjek dari 60 penderita stroke akut berhasil menjalani 7 hari penelitian ini. Hasil penelitian menunjukkan bahwa pemberian NETP dapat meningkatkan kadar prealbumin serum, menurunkan ekskresi kreatinin urin, dan memperkecil penurunan kadar albumin serum dibandingkan kelompok kontrol. (Med J Indones 2004; 14: 37-43)

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The objective of this study was to determine the effect of high protein enteral nutrition on protein status in acute stroke patients. The subjects were divided into two groups using block randomisation, i.e. the intervention group that received high protein enteral nutrition (HPEN), and the control group that received enteral hospital diet. Thirty six out of 60 acute stroke patients had completed 7 days of follow-up. The results showed that HPEN have increased prealbumin level, decreased urinary creatinine excretion, and decreased the decline of albumin serum compared to the control group. (Med J Indones 2004; 14: 37-43)"

"Tujuan: (1) mengetahui perubahan komposisi cairan tubuh dalam 24 jam pasca bedah pintas koroner dengan pintas jantung paru (BPK+PJP); (2) mengetahui besarya katabolisme protein dalam 24 jam pasca PBK+PJP; (3) mengetahui hubungan antara perubahan cairan infra sal (OS) dengan katabolisme protein. Tempat: Unit Terapi Intensif Rumah Sakit Jantung Harapan Kita Metodologi: Setelah mendapat persetujuan etik dari komite etik penelitian medis NCC, Harapan Kita Hospital, diperoleh 20 pasien laki-laki dengan BPK terencana. Volume cairan tubuh diukur dengan multiple frequency bioelecirical impedance (Dietosystem, Italy) pada frekuensi 1, 50, dan 100 kHz dengan menggunakan formula Guricci. Impedans diukur, 1 kali pra bedah dan 3 kali pasca bedah setiap 8 jam. Perubahan komposisi cairan tubuh dinilai dengan uji-t untuk 2 kelompok berpasangan. Nitrogen urea urin (NUU), kreatinin urin dan imbang nitrogen digunakan sebagai indikator katabolisme protein dengan menampung urin 8 jam pada interval yang sama dengan pe ukuran MFBIA Imbang nitrogen diperoleh dengan menghitung asupan dan NUU 24 jam pasta bedah. Hubungan antara perubahan cairan infra sel (CIS) dengan indikator katabolisme dihitung dengan uji korelasi Spearman Rank Hasil: Nilai ZI00 adalah 479 5l, indeks impedans 57,3 cm2/Q, dan volume cairan tubuh total (CM') 33,1 L terdiri dari 44,0% cairan ekstra sel (CES) dan 56,0% CIS. Pra bedah pasien termasuk euvolemia. Intra bedah terjadi imbang cairan +1744 (826-4312) mL. Delapan jam pertama terjadi peningkatan bermakna dari cairan tubuh. Dalam 24 jam pasca BPK+PJP terjadi peningkatan CTT 16,0%; CES 20,7%, dan CIS 13,0%. Peningkatan cairan masih dalam nilai euvolemia. Tidak terdapat hubungan bermakna antara perubahan volume cairan tubuh yang diukur dengan MFBIA dan imbang cairan. Median asupan selama 24 jam pasca bedah adalah 926 (127-1903) kkal dan 28 (0-69) g protein. Secara statistik terjadi peningkatan bermakna dari NUU pada 8 jam ketiga pasca BPK+PIP. Tidak terdapat perbedaan bermakna antara kreatinin urin pra bedah dan pasca bedah. Median imbang nitrogen -8{(-12,7) - (-1,6)} g. Terdapat korelasi negatif antara peningkatan volume CIS dan NUU (r - 0,57; p = 0,01). Kesimpulan Penelitian ini menunjukkan kompartemen cairan tubuh meningkat dalam 24 jam pasca BPK+PJP. Katabolisme protein ringan terjadi dalam 24 jam pasca BPK+PTP. Terdapat korelasi negatif antara peningkatan volume CIS dengan NUU, namun diperlukan penelitian lebih lanjut untuk menjelaskan hubungan ini, terutama pada pasien BPK+PJP".

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The Correlation Between Intra Cellular Water And Protein Catabolism After Coronary Artery Bypass Grafting: Using Multiple Frequency Bioelectrical Impedance Objective: (1) to investigate the changes of body water compartment within 24 hours after elective coronary artery bypass grafting (CABG) surgery with extracorporeal circulation; (2) to observe protein catabolism within 24 hours after elective CABG with extracorporeal circulation, and (3) to correlate between the changes of intra cellular water (ICW) with protein catabolism indicators. Location: Intensive Care Unit, Harapan Kita National Cardiac Center, Jakarta. Subjects and Methods: Twenty male patients with coronary artery disease were recruited for the study. Impedance was measured at 1, 50, 100 kHz using multiple frequency bioelectrical impedance (Dietosystem, Italy) four times: at baseline, at the 1°, 2 and 3 8 hours after surgery. The volume of body water compartment was calculated using Guricci's formula. Urinary urea nitrogen (UUN) and urinary creatinine were assessed using 8-hour urine collection within 24-hour period. Nitrogen balance was calculated by subtracting nitrogen intake with urinary nitrogen. The correlation between the changes of ICW and protein catabolism indicators was tested with Spearman Rank Correlation. Results: At the baseline, mean values of Ziw impedance and impedance index were 479 S~ and 57.3 cm21n, respectively. Mean total body water (TBW) was 33.1 ± 3.1 L or 48.8% of body weight, consist of 44.0% ECW and 56.0% ICW. This composition was classified as euvolemic. Median intra-operative fluid balance was 1744 (826-3412) mL. Significant increased in TBW, ECW, and ICW was observed at the 1' 8 hours. At the 3'a 8 hours after surgery, TRW, ECW, and ICW increased by 16.3%, 20.7%, and 12.8%, respectively, but the values were within desirable ranges. There was no correlation between TBW changes measured by MFBIA and calculated fluid balance. During 24 hours after surgery, median total energy intake was 926 (127-1903) kcal and protein intake was 28 (0-69) g. UUN increased significantly at the 3'd 8 hours after surgery. No significant difference in urinary creatinine was observed between before and after surgery. Nitrogen balance was -8 ((-12,7)-(-1.6)) g, and there was a negative correlation between ICW changes and NL-U (r = - 0.57; p = 0.01). Conclusions: The current study indicates that changes of body water compartment occur during 24 hours after CABG, ICW increases within 24 hours after CABG. Mild protein catabolism occurs within 24 hours after CABG. ICW changes have negative correlation with NULL However further comprehensive study is needed to explain this association, especially in CABG patients."