Oleh Admin Kalbe Medical pada July 17, 2017 07:30

Early vs Late Pemberian Nutrisi Parenteral pada Pasien Critical Ill, Kapankah Waktu yang Tepat?

Critical ill memicu terjadinya anoreksia dan ketidakmampuan untuk makan secara normal, kondisi ini menyebabkan terjadinya defisiensi nutrisi, hilangnya massa otot, kelemahan, dan lamanya penyembuhan. Jalur pemberian, waktu yang tepat untuk memulai pemberian nutrisi artifisial, jumlah kalori, dan jenis nutrien merupakan hal yang penting. Nutrisi enteral dihubungkan dengan rendahnya kejadian komplikasi dibandingkan dengan nutrisi parenteral dan lebih murah untuk jalur pemberiannya. Namun, pemberian nutrisi enteral tunggal kadang tidak dapat mencapai target kalori. Selain itu, kejadian underfeeding dihubungkan dengan terjadinya kelemahan, infeksi, meningkatnya lama penggunaan ventilator, bahkan kematian. Kombinasi nutrisi parenteral dan enteral merupakan strategi yang tepat untuk mencegah terjadinya defisiensi nutrisi tetapi hal yang perlu diperhatikan antara lain terjadinya overfeeding, bahkan berhubungan juga dengan terjadinya disfungsi liver, infeksi, dan perpanjangan penggunaan ventilator.

Guidelines nutrisi yang telah ada untuk dukungan nutrisi pada critical ill sebagian besar berdasarkan opini ahli. Guidelines ESPEN merekomendasikan bahwa para praktisi sebaiknya memulai memberikan nutrisi parenteral dalam 2 hari setelah dirawat di ICU untuk pasien-pasien yang tidak dapat menerima nutrisi enteral secara adekuat. Begitu juga dengan guidelines America dan Canadian yang merekomendasikan pemberian nutrisi enteral segera, tetapi disarankan nutrisi parenteral tidak diberikan bersamaan, dikarenakan pemberian hipokalori dapat ditoleransi pada minggu pertama dan tidak menyebabkan malnutrisi.

Pada penelitian ini membandingkan efek pemberian nutrisi parenteral lambat (guidelines Amerika dan Canadian) dengan pemberian awal (ESPEN) terhadap angka kematian dan komplikasi pada pasien dewasa di ICU yang mempunyai risiko secara nutrisi. Metode dan desainnya adalah acak, multisenter, dengan mengumpulkan subjek sebanyak 2312 pasien yang diberikan nutrisi parenteral dalam waktu 48 jam setelah masuk ICU (kelompok early nutrition) dan sebanyak 2328 pasien diberikan nutrisi parenteral setelah 8 hari (kelompok late nutrition). Hasilnya menunjukkan pada kelompok late nutrition lebih awal keluar dari ICU dan rumah sakit (hazard ratio, 1,06; 95% confidence interval [CI], 1,00 s/d 1,13; P = 0,04). Angka kematian di ICU dan rumah sakit serta angka harapan hidup pada 90 hari sama pada kedua kelompok. Pada kelompok late nutrition, kejadian infeksi (22,8% vs 26,2%; P = 0,008) dan kolestasis (p<0,001) lebih rendah dibandingkan dengan kelompok early nutrition.

Summary:
Critical ill memicu terjadinya anoreksia dan ketidakmampuan untuk makan secara normal, kondisi ini menyebabkan terjadinya defisiensi nutrisi, hilangnya massa otot, kelemahan, dan lamanya penyembuhan. Terdapat perbedaan antara guidelines ESPEN dengan Amerika dan Canadian tentang memulai pemberian nutrisi parenteral pada pasien critical ill. Oleh karena itu, dilakukan penelitian dan hasilnya menunjukkan bahwa pemberian nutrisi parenteral early atau late tidak ada perbedaan terhadap angka kematian di ICU dan rumah sakit maupun 90 hari setelah perawatan. (LAI)

Image : Ilustrasi
Referensi:
1.Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically Ill adults. N Engl J Med. 2011;365:506-17.
2. Debaveye Y, Van den Berghe G. Risks and benefits of nutritional support during critical illness. Annu Rev Nutr. 2006;26:513-38

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