Professional Documents
Culture Documents
Marniar C20911804 (GIZI KLINIK) Pembimbing: DR - Abdul Wahab, Span
Marniar C20911804 (GIZI KLINIK) Pembimbing: DR - Abdul Wahab, Span
ABDUL WAHAB,SpAn
impaired immune function A recommended component and of adequate nutrition support is Impaired ventilatory drive early enteral nutrition (EEN)
EN
preserved gut integrity reduction in infectious complications
Inclusion criteria
EN was provided via a nasogastric tube 18 years
expected to be NPO for > 48 hours
Exclusion criteria
life expectancy < 48 hours ICU stay < 48 hours,
severe diarrhea
malabsorptive syndromes
severe pancreatitis
bowel obstruction
perforation
peritonitis
EEN
Patients who received EN at a rate of at least 20 mL/h within 24 hours of admission to the ICU
primary objective
to evaluate the effect of EEN or delayed EN on length of stay in the medical ICU
secondary objectives
evaluation of the time to initiation of EN at the minimum rate (20 mL/h) determination of the effect of EEN or delayed EN on total hospital LOS, duration of mechanical ventilation, risk of pneumonia, risk of bloodstream infection, and hospital mortality
ADVERSE EFFECTS OF EN
gastric intolerance
diarrhea
multiple loose, watery stools noted by the nurse and/or the need for a C. difficile stool test
sinusitis
x-ray or CT scan
Single investigator Baseline information : date and time of admission, age, gender, BMI, comorbidities, and APACHE II score Presence of pneumonia at baseline
EN : time of initiation, formula, goal rate, % achieved, GRV, diarrhea, duration of ventilation, ICU/hospital LOS, insulin, mortality, prokinetic agents, vasopressors, discarge dx
Lab : WBC, Cr, alb, prealb, CRP, culture and X-ray results
P value <.05
Early group :
23.9 h
Delayed group :
2.1 d
the occurrence of sinusitis did not appear to be significantly increased in either group
initiation of EEN has been associated with benefits in surgical/trauma, burn, mechanically ventilated, and pancreatitis patients
decreased length of stay, decreased mortality, reduced risk of infection, shortened duration of mechanical ventilation, and an improved clinical course
variability within our medical ICU in the initiation of nutrition, with only 50% of the eligible patients receiving EEN
EEN was associated with reduced inconsistency was identified Ilan et al (2007) found considerable variability in the in ICU LOS, time on the ventilator, initiation ofanutrition with < 50% application of the achieving goal rate, hospital mortality, and of each group reaching a goal (72.4% of eligible patients) rate occurrence of new pneumonia
Limitation
higher rate of vasopressor use in the delayed group compared with the EEN group small population size the difference in the number of ICU deaths did not reach statistical significance
gastric intolerance
diarrhea
sinusitis
NO SIGNIFICANT INCREASE
EEN
decreased incidence of pneumonia possible related to the decreased time on the ventilator
improvement in patient outcomes associated with the use of EEN in a diverse population of critically ill patients < 50% of the patients in each group reached a goal rate of EN