Tesis

Hubungan Skor Modified Nutrition Risk in The Critically Ill dengan Lama Pemakaian Ventilasi Mekanik pada Pasien Sakit Kritis = Association Between Modified Nutrition Risk in The Critically Ill Score and Mechanical Ventilation Duration in Critically Ill Patients.

Latar Belakang: Ventilasi mekanik merupakan salah satu alat bantu pernafasan yang sering digunakan pada pasien sakit kritis. Lama pemakaian ventilasi mekanik berisiko meningkatkan morbiditas dan mortalitas. Salah satu faktor yang dapat memengaruhi lama pemakaian ventilasi mekanik adalah kondisi malnutrisi. Skor modified Nutrition Risk in The Critically Ill (mNUTRIC) merupakan salah satu alat skriniing gizi yang khusus dikembangkan dan divalidasi untuk pasien sakit kritis Metode: Penelitian ini merupakan studi kohort prospektif pada pasien sakit dengan ventilasi mekanik di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Skor mNUTRIC dihitung pada 24 jam pertama intubasi kemudian akan dilihat lama pemakaian ventilasi mekanik. Karakteristik subjek lainnya meliputi usia, jenis kelamin, IMT, status gizi berdasar IMT dan ASPEN, asupan energi dan protein selama peemakaian ventilasi mekanik. Hasil: Terdapat 70 subjek dengan rerata usia 46 tahun dan mayoritas laki-laki (62,9%). Rerata IMT 21,4 kg/m2 dengan mayoritas penelitian memiliki IMT normal dengan status gizi malnutrisi secara klinis. Diagnosis admisi ICU terbanyak adalah dengan pembedahan dan komorbid terbanyak adalah merokok. Median lama perawatan sebelum masuk ICU 2 hari. Sebagian besar subjek memiliki skor APACHE II < 17, skor SOFA < 6, skor m-NUTRIC < 5 dan lama pemakaian ventilasi mekanik 1-6 hari. Median asupan energi sebesar 12 kkal/kgBB/hari dan protein sebesar 0,4 g/kgBB/hari. Skor m-NUTRIC berhubungan dengan lama pemakaian ventilasi mekanik (RR 2,06; IK 95%: 1,149-3,689). Kesimpulan: Terdapat hubungan yang bermakna secara statistik antara skor mNUTRIC dengan lama pemakaian ventilasi mekanik pada pasien sakit kritis
Kata kunci: mNUTRIC, Modified Nutrition Risk in The Critically Ill, Sakit Kritis, Ventilasi Mekanik


Background: Mechanical ventilation is a life-support system used to maintain adequate lung function that is often used in critically ill patients. The duration of mechanical ventilation is at risk of increasing morbidity and mortality. One factor that can affect the duration of mechanical ventilation is malnutrition. The modified Nutrition Risk in The Critically Ill (m-NUTRIC) score is a nutritional screening tool that is specifically developed and validated for critically ill patients. This study was conducted to determine the association between the m-NUTRIC score and the duration of mechanical ventilation. Methods: This study is a prospective cohort study in critically ill patients aged ≥ 18 years with mechanical ventilation who are treated in the intensive care unit of Dr. Cipto Mangunkusumo National Hospital and the University of Indonesia Hospital. The mNUTRIC score was assessed in the first 24 hours after the patient was intubated and then the duration of mechanical ventilation was observed. Other subject characteristics included age, gender, BMI, nutritional status based on BMI and ASPEN, intensive care unit (ICU) admission diagnosis, The Acute Physiology and Chronic Health Evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, length of stay from hospital admission to ICU admission, comorbidities, energy and protein intake during mechanical ventilation. Results: There were 70 subjects with a mean age of 46 years and the majority were male (62.9%). The mean BMI was 21.4 kg/m2 with the majority of studies having normal BMI with clinical malnutrition nutritional status. The most common ICU admission diagnosis was surgery and the most common comorbidity was smoking. The median length of stay before ICU admission was 2 days. Most subjects had an APACHE II score < 17, SOFA score < 6, m-NUTRIC score < 5 and duration of mechanical ventilation 1 -6 days. Median energy intake was 12 kcal/kgBW/day and protein intake was 0.4 g/kgBW/day. The mNUTRIC score was associated with the duration of mechanical ventilation (RR 2.06; 95% CI: 1.149-3.689). Conclusion: There was a statistically significant association between the mNUTRIC score and the duration of mechanical ventilation in critically ill patients.
Keywords: m-NUTRIC, Modified Nutrition Risk in The Critically Ill, Critical Ill, Mechanical Ventilation