Early Enteral Nutrition Feeding in Critically Ill Patients

  • Erwin Kresnoadi Fakultas Kedokteran Universitas Mataram
Keywords: critically-ill patient, nutrition, enteral, care


Dukungan nutrisi merupakan komponen penting dalam perawatan pasien kritis karena dapat meningkatkan morbiditas, mortalitas, dan lama tinggal. Efek menguntungkan dari nutrisi enteral mencakup pemanfaatan yang lebih baik substrat, pencegahan atrofi mukosa, pelestarian integritas flora usus, dan pelestarian imunokompetensi. Pemberian makanan enteral secara dini mampu mengurangi angka kematian pasien menjadi lebih rendah karena pemberian nutrisi enteral secara dini dapat meningkatkan aliran darah ke saluran pencernaan.


1. Chandra RK. Nutrition, immunity, and infection: present knowledge and future directions. The Lancet. 1983;321(8326):688–691.

2. Bassili HR, Deitel M. Effect of nutritional support on weaning patients off mechanical ventilators. Journal of Parenteral and Enteral Nutrition. 1981;5(2):161–163.

3. Haydock D, Hill G. Improved wound healing response in surgical patients receiving intravenous nutrition. British Journal of Surgery. 1987;74(4):320–323.

4. Sullivan DH, Sun S, Walls RC. Protein-energy undernutrition among elderly hospitalized patients: a prospective study. Jama. 1999;281(21):2013–2019.

5. Robinson G, Goldstein M, Levine GM. Impact of nutritional status on DRG length of stay. Journal of Parenteral and Enteral Nutrition. 1987;11(1):49–51.

6. Sena MJ, Utter GH, Cuschieri J, Maier RV, Tompkins RG, Harbrecht BG, et al. Early supplemental parenteral nutrition is associated with increased infectious complications in critically ill trauma patients. Journal of the American College of Surgeons. 2008;207(4):459–467.

7. Radrizzani D, Bertolini G, Facchini R, Simini B, Bruzzone P, Zanforlin G, et al. Early enteral immunonutrition vs. parenteral nutrition in critically ill patients without severe sepsis: a randomized clinical trial. Intensive care medicine. 2006;32(8):1191–1198.

8. Hadfield RJ, Sinclair DG, Houldsworth PE, Evans TW. Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill. American journal of respiratory and critical care medicine. 1995;152(5):1545–1548.

9. Minard G, Kudsk K. Is early feeding beneficial? How early is early? New horizons (Baltimore, Md). 1994;2(2):156–163.

10. Gianotti L, Alexander JW, Nelson JL, Fukushima R, Pyles T, Chalk CL. Role of early enteral feeding and acute starvation on postburn bacterial translocation and host defense: prospective, randomized trials. Critical care medicine. 1994;22(2):265–272.

11. Chuntrasakul C, Siltharm S, Chinswangwatanakul V, Pongprasobchai T, Chockvivatanavanit S, Bunnak A. Early nutritional support in severe traumatic
patients. Journal of the Medical Association of Thailand= Chotmaihet thangphaet. 1996;79(1):21–26.

12. Tanigawa K, Kim YM, Lancaster JR, Zar HA. Fasting augments lipid peroxidation during reperfusion after ischemia in the perfused rat liver. Critical care
medicine. 1999;27(2):401–406.

13. Bortenschlager L, Roberts PR, Black KW, Zaloga GP. Enteral feeding minimizes liver injury during hemorrhagic shock. Shock. 1994;2(5):351–354.

14. Brandstrup B R Beier-Holgersen. Influence of early postoperative enteral nutrition versus placebo on cell-mediated immunity, as measured with the
multitest R CMI. Scandinavian journal of gastroenterology. 1999;34(1):98–102.

15. Shou J, Lappin J, Minnard EA, Daly JM. Total parenteral nutrition, bacterial translocation, and host immune function. The American journal of surgery.

16. Quigley EM, Marsh MN, Shaffer JL, Markin RS. Hepatobiliary complications of total parenteral nutrition. Gastroenterology. 1993;104(1):286–301.

17. Kotzampassi K, Kolios G, Manousou P, Kazamias P, Paramythiotis D, Papavramidis TS, et al. Oxidative stress due to anesthesia and surgical trauma: importance of early enteral nutrition. Molecular nutrition & food research. 2009;53(6):770–779.

18. Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. Journal of Gastrointestinal Surgery. 2009;13(3):569.

19. Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. CHEST Journal. 2006;129(4):960–967.

20. Gallavan R, Chou C. Possible mechanisms for the initiation and maintenance of postprandial intestinal hyperemia. American Journal of Physiology-Gastrointestinal and Liver Physiology. 1985;249(3):G301–G308.

21. Norryd C, Denker H, Lunderquist A, Olin T, Tylen U. Superior mesenteric blood flow during digestion in man. Acta Chirurgica Scandinavica. 1975;141(3):197–202.

22. Kles K, Wallig M, Tappenden K. Luminal nutrients exacerbate intestinal hypoxia in the hypoperfused jejunum. Journal of Parenteral and Enteral Nutrition.

23. Zaloga GP, Roberts PR, Marik P. Feeding the hemodynamically unstable patient: a critical evaluation of the evidence. Nutrition in clinical practice. 2003;18(4):285–293.

24. Kazamias P, Kotzampassi K, Koufogiannis D, Eleftheriadis E. Influence of enteral nutritioninduced splanchnic hyperemia on the septic origin of splanchnic ischemia. World journal of surgery. 1998;22(1):6–11.

25. Revelly JP, Tappy L, Berger MM, Gersbach P, Cayeux C, Chiolero R. Early metabolic and splanchnic responses to enteral nutrition in postoperative cardiac surgery patients with circulatory compromise. Intensive care medicine. 2001;27(3):540–547.

26. Board A. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Journal of Parenteral and Enteral Nutrition. 2002;26(1 suppl–2):1SA–138SA.

27. Jolliet P, Pichard C, Biolo G, Chiolero R, Grimble ´G, Leverve X, et al. Enteral nutrition in intensive care patients: a practical approach. Intensive care
medicine. 1998;24(8):848–859.

28. McClave SA, Chang WK. Feeding the hypotensive patient: does enteral feeding precipitate or protect against ischemic bowel? Nutrition in clinical practice. 2003;18(4):279–284.

29. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. Journal of Parenteral and Enteral nutrition. 2003;27(5):355–373.

30. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Critical care medicine. 2001;29(12):2264–2270.

31. Melis M, Fichera A, Ferguson MK. Bowel necrosis associated with early jejunal tube feeding: a complication of postoperative enteral nutrition. Archives
of Surgery. 2006;141(7):701–704.

32. Doig GS, Simpson F, Finfer S, Delaney A, Davies AR, Mitchell I, et al. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. Jama. 2008;300(23):2731–2741.

33. Purcell PN, Davis K, Branson RD, Johnson DJ. Continuous duodenal feeding restores gut blood flow and increases gut oxygen utilization during PEEP ventilation for lung injury. The American journal of surgery. 1993;165(1):188–194.
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