Meike Mayasari
Nutrition Department, Dr. Sardjito Hospital, Yogyakarta, Indonesia, Jalan Kesehatan No. 1, Sekip, Sinduadi, Yogyakarta, 55284

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Evaluation of the provision of enteral nutrition in critically ill patients receiving mechanical ventilation Mayasari, Meike; Mahmudah, Fella Farikhatul; Perwitasari, Silviana; Rahayu, Umi
Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics) VOLUME 11 ISSUE 1, 2023
Publisher : Alma Ata University Press

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21927/ijnd.2023.11(1).30-39

Abstract

                                                            ABSTRACTBackground: Providing enteral nutrition to ICU patients is often challenging, leading to sufficient enteral nutrition that is hardly achieved. This condition is caused by gastrointestinal motility disorder and other complications that often happen during enteral nutrition provision. Therefore, it is important to understand the level of nutritional support and the challenges in the form of interruption during enteral nutrition to critically ill patients receiving mechanical ventilation to optimise the benefit of nutritional support for patients, including reducing the duration of hospitalisation and mortality.Objectives: This study aims to evaluate the provision of enteral nutrition and identify the cause of interruption for patients with mechanical ventilation in one of the tertiary hospitals in Yogyakarta, Indonesia who receive enteral nutrition.Methods: This is a cross-sectional study. The subject of the study is patients who fulfil the inclusion and exclusion criteria. Inclusion criteria include patients who were in ICU for ≥72 hours, receiving mechanical ventilation. While the exclusion criteria include patients with contraindications for enteral nutrition such as unstable haemodynamic, bowel obstruction, persistent severe ileus, gastrointestinal bleeding, nasogastric tube (NGT) placement is not possible, patients receiving oral nutrition with non-invasive ventilation, patients with feeding tube before admission, or patients from other ICU or HCU.Results: Patients needed, on average, 13 hours to receive initial enteral nutrition (SD ± 9.89 hours), with a period between 0 – 50 hours since admission to ICU. The mean time for patients to receive full feeding is 4 days ± 2.4 days. On the other hand, 16 out of 75 patients (21.2%) did not reach the targeted intake during admission. The cause of the interruption of enteral nutrition includes gastric residual volume (GRV), percutaneous dilatation tracheostomy (PDT) procedure, vomiting, bloating, surgery, CT scan, etc.Conclusion: Many causes of interruption and inadequate intake of enteral nutrition can be prevented. The absence of protocol agreed upon by the patient care team could be one of the influencing factors.KEYWORD:  enteral nutrition; enteral nutrition interruption; mechanical ventilation 
Standardized Nutrition Care Process for Critically Ill Patients with Traumatic Brain Injury, Pulmonary Contusion, and Alcohol Intoxication Setyaji, Diyan Yunanto; Suryani, Isti; Lestari, Nugraheni Tri; Iskandar, Slamet; Mayasari, Meike
Journal of Global Nutrition Vol 5 No 2 (2025)
Publisher : Ikatan Sarjana Gizi Indonesia (ISAGI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53823/jgn.v5i2.113

Abstract

Disturbed intake factors, hypermetabolism and hypercatabolism in critical patients cause increased energy needs. Critical patients are very susceptible to nutritional deficiencies resulting in decreased immune systems, poor wound healing, and organ failure that prolongs hospitalization and increases mortality. In these circumstances, nutrition becomes an important part of clinical medical therapy. This study was conducted to implement nutritional services and standardized nutritional care processes in patients with a medical diagnosis of Decreased Consciousness e.c. Severe Head Injury e.c. Traumatic Intracerebral Haemorrhage (TICH), Traumatic Subarachnoid Haemorrhage (TSAH), Intraventricular Haemorrhage (IVH), Pulmonary Contusion, Right Antebrachial Trauma, Close Fracture Ulna 1/3 Distal Right, Alcohol Intoxication, Brainstem Contusion in the Gatotkaca Ward 4 MICU Dr. Sardjito General Hospital. This study uses a descriptive qualitative research design with a case study design. This study used primary and secondary data with data presentation in narrative, tabular, and graphical form. Based on NRS 2002 screening, the patient was at risk of malnutrition. The food intake graph for six days with a high energy and protein diet in the form of enteral per NGT or parenteral diet showed fluctuations in intake from 8.30% on the first day to 33.78% on the sixth day. Acceptance of the NGT diet decreased since the third day as indicated by low absorption and gastric residue. The results of the blood gas analysis showed that the patient had respiratory acidosis. It can be concluded that the standardized nutritional care process and collaboration between health professionals that are carried out optimally and intensively cannot always provide a good prognosis in cases of severe head injury with various complications such as alcohol intoxication, pulmonary contusion, and brainstem contusion.