ABSTRAK 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 2448 jam setelah luka bakar, sebesar 10 kkal/kg BB, menggunakan
drip intermiten. Selanjutnya, nutrisi diberikan sebesar 2025 kkal/kg BB pada
fase akut dan 2530 kkal/kg BB/hari pada fase anabolik. Setelah pasien keluar
dari intensive care unit (ICU), target kebutuhan energi menggunakan persamaan
Xie, dengan protein 1,52,0 g/kg BB/hari, lemak 2530%, dan karbohidrat (KH)
5565%. 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 510 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.
ABSTRACT 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 2448 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 2025 kcal/kg
BW/day in acute phase or 2530 kcal/kg BW/day in anabolic recovery phase. Xie
Equation was used to calculate target of total energy for burned patient. Protein
requirement was 1.52.0 g/kg BW/day. Lipid and carbohydrate given were
2530% and 5565% 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
510 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.
;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 2448 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 2025 kcal/kg
BW/day in acute phase or 2530 kcal/kg BW/day in anabolic recovery phase. Xie
Equation was used to calculate target of total energy for burned patient. Protein
requirement was 1.52.0 g/kg BW/day. Lipid and carbohydrate given were
2530% and 5565% 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
510 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.
;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 2448 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 2025 kcal/kg
BW/day in acute phase or 2530 kcal/kg BW/day in anabolic recovery phase. Xie
Equation was used to calculate target of total energy for burned patient. Protein
requirement was 1.52.0 g/kg BW/day. Lipid and carbohydrate given were
2530% and 5565% 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
510 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.
;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 2448 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 2025 kcal/kg
BW/day in acute phase or 2530 kcal/kg BW/day in anabolic recovery phase. Xie
Equation was used to calculate target of total energy for burned patient. Protein
requirement was 1.52.0 g/kg BW/day. Lipid and carbohydrate given were
2530% and 5565% 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
510 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.
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