Tesis

Terapi Medik Gizi pada Pasien Sakit Kritis dengan Sindroma Guillain-Barre = Medical Nutrition Therapy in Critically Ill Patients with Guillain-Barre Syndrome.

Latar Belakang: Sindroma Guillain-Barre merupakan kondisi kritis dengan k ebutuhan energi meningkat sesuai dengan hiperkatabolisme sehingga meningkatkan risiko malnutrisi. Malnutrisi dapat mengurangi kemampuan otot diafragma, dan meningkatkan risiko infeksi yang akan memperberat kondisi sakit kritis. Terapi medik gizi bertujuan menyediakan substrat energi, mengurangi respons metab olik terhadap stres, memicu respons imun, serta mempertahankan massa bebas lemak. Metode: Serial kasus ini melaporkan empat pasien sakit kritis dengan sindroma Guillain-Barre berusia antara 21–58 tahun. Keempat pasien memiliki status gizi obes berdasarkan kriteria World Health Organization (WHO) Asia Pasifik. Terapi medik gizi diberikan sesuai pedoman pada keadaan sakit kritis dimulai dengan enteral dini dengan target 20–25 kkal/kg BB (fase akut) dan protein 1,2–2 g/kg BB. Pemberian nutrisi ditingkatkan bertahap sesuai klinis dan toleransi saluran cerna. Mikronutrien diberikan vitamin D 3 , B, C, seng. Hasil: Tiga pasien pulang dengan perbaikan kekuatan motorik dengan lama perawatan intensif yang bervariasi, sedangkan satu pasien masih dalam perawatan karena membutuhkan ventilasi mekanik. Kesimpulan: Terapi medik gizi adekuat menunjang proses penyembuhan penyakit dan memperbaiki kapasitas fungsional.
Kata Kunci: Sakit kritis, sindroma Guillain-Barre, terapi medik gizi


Background: Guillain-Barre syndrome is a critical ill condition with in creased energy requirement in line with hypercatabolism state, thus increased malnutrition risk. Maln utrition could aggravate diaphragm weakness and increased risk of infection. The aim of medical nutrition therapy was to provide energy substrate, decreased metabolic response, induced imun response, and to maintain free-fat mass. Methods: The current case series reported four critically ill patients with GuillainBarre syndrome aged 21–58 years old. All four patients are obese according to World Health Organization (WHO) Asia Pacific criteria. Medical nutrition therapy was given based on nutrition guidelines for critically ill patient started with early enteral nutrition. Energy was targeted at 20–25 kcal/kg/day (acute phase) and protein at 1,2–2 g/kg. Micronutrients include vitamin D , B, C, and seng. Results: Three patients discharged with improved motoric strength and prolong hospitalization. The other patient still in hospitalization requiring mechanical ventilation. Conclusion: Adequate medical nutrition therapy supports healing process and improves functional capacity.
Keywords: Critically ill, Guillain-Barre syndrome, medical nutrition therapy