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Abstrak :
ABSTRAK
Salah satu upaya dalam mencegah terjadinya komplikasi infeksi di intensive care unit dengan memonitoring pH cairan lambung khususnya pada pasien terpasang ventilasi mekanik. Penelitian ini bertujuan mengidentifikasi perbedaan pemberian nutrisi enteral metode intermittent dan bolus feeding terhadap pH cairan lambung pasien dengan ventilasi mekanik. Penelitian ini menggunakan desain quasi experiment pada 30 responden. Kelompok pertama (15 responden) mendapatkan intervensi intermittent feeding dan kelompok kedua (15 responden) mendapatkan intervensi bolus feeding. Uji perbedaan hasil menggunakan chi-square, pooled t test dan paired t test. Hasil penelitian (between groups) menunjukkan adanya perbedaan pH cairan lambung yang bermakna pada kelompok yang mendapatkan terapi nutrisi enteral metode intermittent dan bolus feeding pada pasien dengan ventilasi mekanik (p < 0,05). Penelitian merekomendasi perawat untuk dapat melakukan tindakan pemberian nutrisi enteral dengan metode yang tepat dan berupaya menerapkan tindakan pencegahan terhadap komplikasi lebih lanjut akibat pemberian nutrisi enteral sehingga akan memperbaiki sistem layanan asuhan keperawatan.

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ABSTRACT
One of the most common strategy to prevent infection complications in intensive care unit by monitoring pH gastric especially to patients with mechanical ventilation. The purpose of this study is to identify the difference intermittent and bolus feeding to pH gastric in patients with mechanical ventilation. The study design quacy experiment with sample of 30 respondents. First group (15 respondents) getting intermittent feeding and second group (15 respondents) getting bolus feeding. Data were analyzed using chi-square, pooled t test and paired t test. The results showed that there is a significant different of pH gastric between intermittent feeding and bolus feeding in patient with mechanical ventilation (p <0.05). Further study recommends nurses to provision enteral nutrition with right method and sought to apply complication preventive by the result of enteral nutrition.

Abstrak :
Pasien rawat inap banyak yang mengalami malnutrisi di rumah sakit (RS). Malnutrisi dihubungkan dengan berbagai komplikasi, seperti risiko yang lebih tinggi mengalami infeksi, memperpanjang masa rawat (length of stay), meningkatkan biaya rawat, serta meningkatkan risiko morbiditas dan mortalitas. Variabilitas prevalensi malnutrisi masih banyak terjadi, akibat banyaknya instrumen skrining dan asesmen serta batas ambang penentuan malnutrisi. Kriteria malnutrisi terbaru menurut Global Leadership Initiative on Malnutrition (GLIM) mengusulkan model dua langkah untuk mendiagnosis malnutrisi di RS. Penelitian ini bertujuan untuk menguji kesahihan kriteria diagnosis GLIM dibandingkan dengan ASPEN dalam mendiagnosis malnutrisi pada pasien rawat inap dewasa. Penelitian menggunakan desain potong lintang pada subjek dewasa yang dirawat inap di RSCM. Setiap pasien didiagnosis menggunakan kriteria GLIM dan ASPEN oleh dokter yang berbeda. Sebanyak 100 subjek penelitian dengan median usia 44,5 tahun, mayoritas perempuan, diagnosis malnutrisi menurut kriteria GLIM paling banyak didapatkan pada pasien penyakit saluran cerna, hepatobilier dan pankreas 69% (20 dari 29 subjek) yang diikuti dengan penyakit keganasan 47% (10 dari 21 subjek). Menurut kriteria ASPEN, terdapat 48% pasien malnutrisi dengan rincian 22% malnutrisi sedang dan 26% malnutrisi berat. Menurut kriteria GLIM, terdapat 63% pasien dengan malnutrisi. Kriteria malnutrisi GLIM memiliki sensitivitas 97,9%, spesifisitas 69,2%, NPP 74,6%, dan NPN 97,3%. Uji chi square menunjukkan adanya perbedaan signifikan (p = 0.000) antara GLIM dan ASPEN. Uji Cohen’s Kappa menunjukkan nilai k = 0,663 dan nilai p = 0.071 yang menunjukkan kesepakatan antara diagnosis GLIM dengan ASPEN dengan tingkat sedang (nilai k = 0,61-0,8) dan tidak signifikan. Median total lymphocyte count (TLC) adalah 1,725/mm3 dengan TLC terendah 340/mm3 dan tertinggi 15,660/mm3. Median kadar albumin adalah 3,85 g/dl dengan nilai terendah 1,1 g/dl dan tertinggi 5,4 g/dl. ......Many inpatients are malnourished in the hospital (RS). Malnutrition is associated with various complications, such as a higher risk of infection, length of stay, increased hospitalization costs, and increased risk of morbidity and mortality. There is still a lot of variability in the prevalence of malnutrition, due to the large number of screening and assessment instruments and the threshold for determining malnutrition. The latest malnutrition criteria according to the Global Leadership Initiative on Malnutrition (GLIM) proposes a two-step model for diagnosing malnutrition in hospitals. This study aimed to examine the validity of the GLIM diagnostic criteria compared to ASPEN in diagnosing malnutrition in adult hospitalized patients. The study used a cross-sectional design on adult subjects who were hospitalized at RSCM. Each patient was diagnosed using the GLIM and ASPEN criteria by a different physician. A total of 100 patients with a median age of 44.5 years participated in the study, the majority were women, the diagnosis of malnutrition according to the GLIM criteria was mostly found in patients with gastrointestinal, hepatobiliary, and pancreatic diseases 69% (20 of 29 subjects) followed by malignancy 47% (10 of 21 subjects). According to ASPEN criteria, there were 48% of malnourished patients, 22% moderate malnutrition and 26% severe malnutrition, meanwhile according to the GLIM criteria, there are 63% of patients with malnutrition. The GLIM malnutrition criteria had a sensitivity of 97.9%, specificity of 69.2%, PPV 74.6%, and NPV 97.3%. The chi square test showed a significant difference (p = 0.000) between GLIM and ASPEN. Cohen's Kappa test showed a value of k = 0.663 and a value of p = 0.071 which indicated a moderate (k = 0.61-0.8) and insignificant agreement between the diagnosis of GLIM and ASPEN. The median total lymphocyte count (TLC) was 1.725/mm3 with the lowest TLC of 340/mm3 and the highest of 15,660/mm3. The median albumin level was 3.85 g/dl with the lowest value 1.1 g/dl and the highest 5.4 g/dl.

Abstrak :
Malnutrisi pada anak sakit kritis dalam perawatan intensif menjadi masalah dalam beberapa dekade terakhir dan berhubungan erat dengan morbiditas dan mortalitas. Hingga kini, Rumah Sakit Cipto Mangunkusumo (RSCM) belum memiliki panduan baku mengenai dukungan nutrisi anak sakit kritis. Penelitian bertujuan untuk mengetahui profil pemberian nutrisi enteral (NE) dan waktu pencapaian resting energy expenditure (REE) di Pediatric Intensive Care Unit (PICU) RSCM dan faktor-faktor yang memengaruhi. Penelitian dilakukan secara retrospektif dengan menggunakan data rekam medis anak sakit kritis yang dirawat di PICU RSCM pada tahun 2017-2018. Waktu inisiasi pemberian NE dan pencapaian REE serta faktor-faktor yang memengaruhi pemberian tersebut dicatat dan dilakukan analisis multivariat untuk mencari faktor risiko yang bermakna. Terdapat 203 pasien yang memenuhi kriteria inklusi. Terdapat 120 subyek berjenis kelamin lelaki (59,1%), dengan median usia adalah 35 bulan (rentang usia 1-209 bulan). Kasus bedah terdapat pada 125 subyek (61,6%) dan status gizi normal terdapat pada 87 subyek (42,9%). Prevalensi pemberian NE dini adalah 63,1%, dan pencapaian kalori REE ≤72 jam adalah 67,5%, dengan median 48 jam. Faktor risiko yang menghambat pemberian NE dini adalah pasca-bedah abdomen, penggunaan inotropik, penggunaan ventilator, gejala gastrointestinal sebelum inisiasi, dan status gizi tidak normal dengan odds ratio (OR) 10,89 (IK 95% 4,31-27,50; p=0,009), 4,60 (IK 95% 1,78-11,90; p=0,002), 4,18 (IK 95% 1,56-11,17; p=0,004), 3,40 (IK 95% 1,59-7,29; p=0,002), 2,49 (IK 95% 1,09-5,72; p=0,031). Faktor risiko yang menghambat pencapaian kalori REE ≤72 jam adalah pemberian NE lambat, intoleransi pemberian enteral berupa gejala gastrointestinal dan skor PELOD-2 ≥7 dengan OR 20,62 (IK 95% 6,48-65,65; p=0,000), 14,77 (IK 95% 4,40-49,60; p=0,000), 3,98 (IK 95% 1,01-15,66; p=0,048). Prevalensi pemberian NE dini pada anak sakit kritis di PICU RSCM cukup baik dengan waktu pencapaian REE sesuai dengan target. Faktor terbanyak penghambat pemberian NE dini adalah kondisi pasca-bedah abdomen, sedangkan faktor penghambat pencapaian REE ≤ 72 jam terbanyak adalah pemberian NE lambat. ......Malnutrition of critically ill children remains a major problem that is closely related to high morbidity and mortality in pediatric intensive care unit (PICU) during the last decades. The protocol of nutritional support for critically ill children in Cipto Mangunkusumo Hospital (CMH) has not yet been developed. The study is aimed to evaluate the enteral nutrition (EN) profile, the duration to achieve resting energy expenditure (REE) and number of influencing factors associated with the late EN administration and late REE achievement. The data were collected retrospectively from medical records during the year 2017 to 2018 in PICU CMH. We assessed the timing of EN given and the duration of REE achieved from EN. We performed multivariate analysis to determined significant factors associated with late EN and late REE achievement. Two hundred three subjects were included. One hundred twenty subjects (59%) were boys, with median age of 35 (1-209) months old. One hundred twenty five subjects (61.6%) were post-surgical period and 87 subjects (42.9%) were in good nutritional status. The prevalence of early EN was 63.1%, and REE ≤72 hours was achieved in 67.5% subjects, with the median time was 48 hours. Significant factors inhibit early EN administration were post-abdominal surgery, ventilator use, inotropic use, gastrointestinal symptoms before initiation, and abnormal nutritional status; with OR 10.89 (95% CI 4.31 to 27.50; p=0.009), 4.60 (95% CI 1.78 to 11.90; p=0.002), 4.18 (95% CI 1.56 to 11.17; p=0.004), 3.40 (95% CI 1.59 to 7.29; p=0.002), 2.49, 95% CI 1.09 to 5.72; p=0.031), respectively. While factors inhibit the achievement of REE ≤72 hours were the late EN initiation, enteral intolerance, and PELOD-2 score ≥7 with OR 20.62 (95% CI 6.48 to 65.65; p=0.000), 14.77 (95% CI 4.40 to 49.60; p=0.000), 3.98 (95% CI 1.01 to 15.66; p=0.048), respectively. The prevalence of early EN administration with the duration to achieve REE among critically ill children in the PICU CMH was quite satisfying. The most influencing factor inhibit early EN administration was post-abdominal surgery, while the most significant factor inhibit the achievement of REE ≤72 hours was the late NE administration.