Tesis

Peran Terapi Medik Gizi dan Suplementasi Vitamin D pada Pasien Penyintas Acute Respiratory Distress Syndrome = Role of Medical Nutrition Therapy and Vitamin D Supplementation in Acute Respiratory Distress Syndrome Survivors: Case Series.

Penyintas Acute Respiratory Distress Syndrome (ARDS) berisiko tinggi mengalami penurunan massa, kekuatan, dan performa otot yang menyebabkan disabilitas dan penurunan kualitas hidup. Sementara itu, belum ada pedoman terapi medik gizi untuk fase pemulihan setelah perawatan intensive care unit (ICU), dan suplementasi vitamin D juga belum rutin dilakukan. Serial kasus ini melaporkan terapi medik gizi dan suplementasi vitamin D pada empat kasus ARDS. Serial kasus terdiri atas tiga pasien perempuan dan satu pasien laki-laki. Keempat pasien memiliki komorbid dan penyulit yang berbeda, Berdasarkan kriteria malnutrisi American Society for Parenteral and Enteral Nutrition (ASPEN)/ Perhimpunan Dokter Spesialis Gizi Klinik Indonesia (PDGKI), tiga orang berisiko malnutrisi, sementara satu orang malnutrisi berat secara klinis. Selama perawatan, asupan energi ditingkatkan bertahap melalui kombinasi nutrisi parenteral, enteral melalui nasogastric tube (NGT), dan oral. Kebutuhan energi total menggunakan perhitungan kebutuhan energi basal sesuai formula Harris-Benedict ditambah faktor stres antara 1,6–1,7 yang disesuaikan dengan profil klinis dan metabolik pasien. Kebutuhan protein ditetapkan 1,5–2,5 g/kg BB/hari. Lemak dan karbohidrat (KH) disesuaikan dengan komposisi seimbang dengan memerhatikan kebutuhan untuk pasien DM, yaitu 25–30% lemak, < 7% lemak jenuh, ~10% asam lemak tak jenuh jamak, ~20% asam lemak tak jenuh tunggal, 45–60% KH, < 5% gula sederhana untuk pasien DM dan < 10% untuk pasien non-DM. Tiga pasien mengalami defisiensi vitamin D (10,9 ng/mL, 11,2 ng/mL, dan 13,1 ng/mL), sementara satu pasien mengalami insufisiensi vitamin D (25,8 ng/mL). Tiga pasien mendapatkan suplementasi kolekalsiferol 6000 IU/hari selama dua bulan, sementara satu pasien selama satu bulan. Setelah mendapatkan terapi medik gizi adekuat dan suplementasi vitamin D, didapati peningkatan kadar serum vitamin D menjadi sufisien. Selain itu, massa otot, kekuatan genggam, indeks Barthel, dan kualitas hidup berdasarkan Short Form (SF)-12 meningkat meskipun belum mencapai nilai normal. Keempat kasus ini menggambarkan bahwa tata laksana komprehensif yang menyertakan terapi medik gizi adekuat dan evaluasi serum vitamin D dapat meningkatkan kondisi klinis, metabolik, massa dan kekuatan otot, kapasitas fungsional, serta kualitas hidup pasien penyintas ARDS.
Kata kunci: terapi medik gizi, sakit kritis, penyintas ARDS, vitamin D, massa otot, kapasitas fungsional, kualitas hidup


Acute respiratory distress syndrome (ARDS) survivors are at risk of experiencing a substantial decrease in muscle mass, strength, and performance, which may cause disability and lower quality of life. However, no guidelines address the medical nutrition therapy (MNT) of ARDS survivors following intensive care unit (ICU) discharge, and vitamin D supplementation has not been routinely done. This case series reports MNT and vitamin D supplementation in four ARDS survivors. There were three women, and one man, all of them had different comorbidities. According to the American Society for Parenteral and Enteral Nutrition (ASPEN) malnutrition criteria, one patient was severely malnourished. Energy intake was increased by a combination of parenteral, enteral via nasogastric tube (NGT), and oral nutrition. Total energy requirement was calculated using the Harris-Benedict formula with stress factors 1,6– 1,7, according to patients’ clinical and metabolic profiles. Protein requirement was set by 1,5–2,5 g/kg body weight (BW)/day. Fat and carbohydrate (CHO) were tailored by balance composition, also regarding DM needs, i.e., 25–30% fat, < 7% saturated fatty acid, ~10% polyunsaturated fatty acid (PUFA), ~20% monounsaturated fatty acid (MUFA), 45–60% CHO, < 5% added sugar for DM and < 10% for non-DM. Three patients had vitamin D deficiency (10,9 ng/mL, 11,2 ng/mL, dan 13,1 ng/mL), which had 6000 IU/day cholecalciferol supplementation for two months, and one patient had vitamin D insufficiency (25,8 ng/mL), which had 6000 IU/day cholecalciferol supplementation for one month. After 1–2 months of MNT and vitamin D supplementation, serum vitamin D is sufficient. Moreover, muscle mass, handgrip strength, Barthel index, and quality of life according to Short Form (SF)-12 were increased. This case series concluded that comprehensive management along with an adequate MNT and vitamin D serum evaluation improved clinical and metabolic condition, muscle mass and strength, functional capacity, and quality of life of ARDS survivors.
Keywords: medical nutrition therapy, critically ill, ARDS survivors, vitamin D, muscle mass, functional capacity, quality of life