Oleh Admin Kalbe Medical pada September 12, 2017 07:30

Pengaruh Densitas Kalori pada Pasien ICU

Hipermetabolisme dan malnutrisi merupakan suatu kondisi umum yang terjadi di ICU (intensive care unit). Malnutrisi dikaitkan dengan peningkatan morbiditas dan mortalitas. Jumlah kalori yang dibutuhkan secara optimal pada pasien dengan penyakit kritis di ICU, khususnya tanpa indirect calorimetry, masih belum diketahui secara jelas. Sebuah tinjauan pustaka yang pernah diterbitkan oleh jurnal Critical Care Medicine pada tahun 2007 lalu menyebutkan pemberian nutrisi awal berkisar 25-66% dari total kalori harian adekuat bagi pasien dengan penyakit kritis di ICU. Pada umumnya nutrisi enteral yang digunakan memiliki densitas kalori 1,0 mL/Kkal.

Sebuah penelitian terbaru yang dilakukan secara acak dan tersamar ganda membandingkan efek dari pemberian nutrisi enteral dengan densitas kalori 1,5 mL/Kkal vs 1,0 mL/Kkal. Subjek sebanyak 112 pasien dengan ventilasi mekanik yang menjalani perawatan di ICU dibagi menjadi 2 kelompok dan menerima nutrisi enteral dengan densitas kalori 1,0 mL/Kkal atau 1,5 mL/Kkal dengan kecepatan pemberian 1 mL/kgBB/jam selama 10 hari. Kandungan protein dan serat pada kedua larutan sebanding.

Setelah 10 hari, hasilnya menunjukkan bahwa acute physiology and chronic health evaluation II score sebanding antara kedua kelompok (p=0,628). Pemenuhan kalori harian pada kelompok 1,5 mL/Kkal lebih tinggi secara bermakna jika dibandingkan dengan kelompok 1,0 mL/Kkal – peningkatan sebesar 46% vs 1,0 mL/Kkal (p<0,001). Pemberian densitas kalori yang lebih tinggi (1,5 mL/Kkal) tidak dikaitkan dengan volume residual lambung yang lebih tinggi atau diare. Terdapat penurunan trend angka mortalitas-90 hari pada kelompok 1,5 mL/Kkal (20%) jika dibandingkan dengan 1,0 mL/Kkal (37%), akan tetapi hasil ini tidak bermakna secara statistik (p=0,057).

Simpulan:
Pemberian nutrisi enteral dengan densitas kalori yang dinaikkan menjadi 1,5 mL/Kkal memberikan pemenuhan kalori harian 46% yang lebih tinggi tanpa efek samping, seperti diare. (LAI)

Image : Ilustrasi
Referensi:
1.Peake SL, Davies AR, Deane AM, Lange K, Moran JL, O'Connor SN1, et al. Use of a concentrated enteral nutrition solution to increase calorie delivery to critically ill patients: A randomized, double-blind, clinical trial. Am J Clin Nutr. 2014;100(2):616-25.
2.Stapleton RD, Jones N, Heyland DK. Feeding critically ill patients: What is the optimal amount of energy? Crit Care Med. 2007;35(9 Suppl):535-40.

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