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"ABSTRAKLatar 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.

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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."

"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.

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;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."

"[Latar belakang: luka bakar akan memicu terjadinya respon inflamasi lokal dansistemik, yang dapat menimbulkan berbagai komplikasi. Pada pasien luka bakar,terjadi peningkatan kebutuhan akan zat gizi akibat kondisi hipermetabolik danhiperkatabolik yang terjadi. Tatalaksana nutrisi yang adekuat dibutuhkan untukmembantu kontrol respon inflamasi dan metabolik sehingga dapat menunjangpenyembuhan pasien. Metode: Dalam serial kasus ini terdapat empat pasien luka bakar berat yang disebabkan api dan listrik. Selama perawatan didapatkan berbagai penyulit yang mempengaruhi tatalaksana nutrisi yang diberikan. Pada pasien pertama terdapattrauma inhalasi, yang berkembang menjadi ARDS dan gagal nafas. Pada pasienkedua terdapat sepsis, yang berkembang menjadi syok sepsis dan gagal organmultipel. Pasien ketiga mengalami amputasi dan AKI, sedangkan pasien keempatmengalami rabdomiolisis, AKI, dan amputasi. Target energi dihitung berdasarkanformula 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 jampasca kejadian sebesar 13?20 kkal/kg/hari dengan metode pemberian dripintermittent. Pemberian nutrisi selanjutnya sesuaikan dengan toleransi, klinis, danpenyulit yang dialami pasien. Mikronutrien yang diberikan berupa multivitaminantioksidan, vitamin B, dan asam folat.Hasil: dua pasien pertama meninggal dalam perawatan, namun pasien pertamatelah mengalami perbaikan luas luka bakar dari 54% menjadi 32,5%. Dua pasienterakhir mengalami perbaikan kapasitas fungsional dan penyembuhan luka yangbaik. 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 majorburn significantly increased because hypermetabolic and hypercataboliccondition. Effective and adequate nutrition therapy is required to controlinflammatory dan metabolic response, therefore enchance healing process.Method: The current case series consists of four patients with severe burn injurycaused by flame and electricity. During hospitalization, complicating conditionsdeveloped in all patients which influenced nutrition therapy given to the patients.First patient had inhalation injury that developed into ARDS and respiratoryfailure, while sepsis that progress to septic shock and MODS occured in secondpatient. Third patient had amputation and AKI, while fourth patient experiencedrhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xieand Harris-Benedict formula with target protein was 1,7?2 g/kgBB, lipid 20?25%,and carbohydrate 60?65%. Enteral nutrition was initiated within 21?35 hours postburn, started at 13?20 Kcal/kg/day with intermintent gravity drip method. Further,nutrition was given according to patients? tolerance, clinical condition, andcomplicating conditions. Micronutients supplementation with antioxidant, vitaminB, and folic acid were provided to all patients.Result: The first two patients died during hospitalization, however, there wasimprovement in first patient?s burn wound extent from 54% to 32,5% TBSA. Thelast two patients had satisfactory wound healing and improvement in functionalcapacity.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 majorburn significantly increased because hypermetabolic and hypercataboliccondition. Effective and adequate nutrition therapy is required to controlinflammatory dan metabolic response, therefore enchance healing process.Method: The current case series consists of four patients with severe burn injurycaused by flame and electricity. During hospitalization, complicating conditionsdeveloped in all patients which influenced nutrition therapy given to the patients.First patient had inhalation injury that developed into ARDS and respiratoryfailure, while sepsis that progress to septic shock and MODS occured in secondpatient. Third patient had amputation and AKI, while fourth patient experiencedrhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xieand Harris-Benedict formula with target protein was 1,7?2 g/kgBB, lipid 20?25%,and carbohydrate 60?65%. Enteral nutrition was initiated within 21?35 hours postburn, started at 13?20 Kcal/kg/day with intermintent gravity drip method. Further,nutrition was given according to patients? tolerance, clinical condition, andcomplicating conditions. Micronutients supplementation with antioxidant, vitaminB, and folic acid were provided to all patients.Result: The first two patients died during hospitalization, however, there wasimprovement in first patient?s burn wound extent from 54% to 32,5% TBSA. Thelast two patients had satisfactory wound healing and improvement in functionalcapacity.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 majorburn significantly increased because hypermetabolic and hypercataboliccondition. Effective and adequate nutrition therapy is required to controlinflammatory dan metabolic response, therefore enchance healing process.Method: The current case series consists of four patients with severe burn injurycaused by flame and electricity. During hospitalization, complicating conditionsdeveloped in all patients which influenced nutrition therapy given to the patients.First patient had inhalation injury that developed into ARDS and respiratoryfailure, while sepsis that progress to septic shock and MODS occured in secondpatient. Third patient had amputation and AKI, while fourth patient experiencedrhabdomiolysis, AKI, and amputation. Target energy was calculated based on Xieand Harris-Benedict formula with target protein was 1,7–2 g/kgBB, lipid 20–25%,and carbohydrate 60–65%. Enteral nutrition was initiated within 21–35 hours postburn, started at 13–20 Kcal/kg/day with intermintent gravity drip method. Further,nutrition was given according to patients’ tolerance, clinical condition, andcomplicating conditions. Micronutients supplementation with antioxidant, vitaminB, and folic acid were provided to all patients.Result: The first two patients died during hospitalization, however, there wasimprovement in first patient’s burn wound extent from 54% to 32,5% TBSA. Thelast two patients had satisfactory wound healing and improvement in functionalcapacity.Conclusion: Effective and adequate nutrition management inline with patient’s clinical condition lead to enhacement healing process, and reduced morbidity and mortality rate.]"

"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.

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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."

"Sepsis adalah keadaan infeksi yang disertai dengan respon infeksi secara sistemik yang merupakan salah satu penyebab morbiditas dan mortalitas pasien dengan penyakit kiritis Penyakit kritis dapat menyebabkan seorang pasien jatuh ke dalam kondisi malnutrisi Prevalensi malnutrisi pada pasien sakit kritis yang dirawat di unit perawatan intensif adalah 50 Tujuan penatalaksanaan nutrisi pasien sepsis adalah untuk menurunkan stres metabolik mencegah kerusakan sel akibat stres oksidatif dan memodulasi fungsi imun Penatalaksanaan nutrisi meliputi kegiatan skrining assessment terapi nutrisi pemantauan dan evaluasi Pasien pada serial kasus ini adalah pasien dewasa dengan diagnosis sepsis yang disebabkan oleh pneumonia 3 pasien dan infeksi intraabdomen 1 pasien Komplikasi sepsis terbanyak dalam serial kasus ini adalah acute kidney injury AKI Kebutuhan energi dihitung berdasarkan rule of thumb yaitu 20 25 kkal kg BB hari pada fase akut dan 25 30 kkal kg BB hari pada fase anabolik Pada pasien yang mendapat continuous renal replacement therapy CRRT diberikan energi 35 kkal kg BB hari Pemberian protein dengan jumlah minimal 1 5 gram kg BB hari diberikan kepada pasien tanpa AKI sementara pada pasien dengan CRRT diberikan protein 1 7 gram kg BB hari Pemantauan terapi nutrisi meliputi tanda klinis toleransi asupan makanan kapasitas fungsional balans cairan parameter laboratorium dan antropometri Selama pemantauan didapatkan semua pasien dapat mencapai kebutuhan energi total dalam waktu kurang dari tujuh hari namun karena terjadi beberapa efek samping seperti peningkatan volume residu lambung dan tekanan karbon dioksida maka dilakukan penurunan asupan pada 2 pasien Pemberian nutrisi pada pasien sakit kritis bersifat individual dan terintegrasi Tatalaksana nutrisi yang baik diharapkan dapat menurunkan laju morbiditas dan mortalitas pasien dengan sepsis

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Sepsis is a state of infection accompanied by systemic inflammatory response syndrome It often associated with increase morbidity and mortality rate in critically ill patient Fifty percent of critically patient admitted in intensive care unit were malnourished Aims of nutritional management of septic patients are to reduce metabolic stress prevent cell damage from oxidative stress and modulate immune function Nutrition intervention in septic patients are including nutrition screening and assessment nutrition therapy monitoring and evaluation Subjects were four adult septic patients caused by pneumonia infection 3 patients and intra abdominal infection 1 patient Most frequent septic complications in this serial case report were acute kidney injury AKI Energy requirementis calculated based on the rule of thumb which is 20 25 kcal kg BW day in the acute phase and 25 30 kcal kg BW day in the anabolic phase Patients whose receiving continuous renal replacement therapy CRRT were given an energy of 35 kcal kg BW day Minimal protein requirement for patient without AKI was 1 5g kg BW day and in patients with CRRT protein intake were 1 7 grams kg BW day Monitoring includes clinical symptoms tolerance of food intake functional capacity fluid balance laboratory and anthropometric findings All patients were able to obtain total energy requirement in less than seven days However reduction of total energy was appied in 2 patients after several days of treatment due to increased gastric residual volume and carbon dioxide pressure Nutrition therapy in critically ill patients is individualized and integrated Proper nutrition therapy may decrease of morbidity and mortality rate in septic patients "

"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

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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 "