Çocuk Sağlığı ve Hastalıkları Çocuk Yoğun Bakım Hastasında Enteral Beslenme
Özet
Çocuk Yoğun Bakım Ünitesi’nde (ÇYBÜ) yatan kritik hastalarda malnütrisyon sık görülen ve hastalığın seyrini olumsuz etkileyen hayati bir sorundur. Hastaların beslenme durumu; detaylı fizik muayene, antropometrik ölçümler (vücut ağırlığı, boy, baş çevresi) ve akut beslenme değişikliklerini en iyi yansıtan prealbümin gibi laboratuvar değerleriyle düzenli olarak değerlendirilmelidir. Kritik hastalık sırasında ortaya çıkan ağır metabolik stres yanıtı, artmış protein katabolizmasına ve net negatif protein dengesine yol açar. Bu süreçte hem yetersiz beslenmeden hem de karaciğer yağlanması ve ventilatörden ayırma başarısızlığına neden olabilen aşırı beslenmeden kaçınılarak hastaya özel optimal beslenme sağlanmalıdır. Enerji ihtiyacının saptanmasında indirekt kalorimetre altın standarttır; bu yöntemin bulunmadığı durumlarda White veya Schofield formüllerinden yararlanılabilir. Kas kütlesi kaybını engellemek ve pozitif nitrojen dengesi elde etmek için ASPEN ve SCCM kılavuzları doğrultusunda günlük en az 1,5 g/kg protein desteği önerilmektedir. Gastrointestinal fonksiyonları korunan çocuklarda beslenmeye ilk 24-48 saat içinde erken enteral yolla başlanmalı, tıbbi prosedürler veya beslenme intoleransı kaynaklı önlenebilir kesintiler en aza indirilmelidir. Gastrik beslenmenin yetersiz veya güvensiz olduğu durumlarda postpilorik beslenme tercih edilebilir. Ayrıca, uzun süreli açlık veya ciddi malnütrisyonu olan çocuklarda yeniden besleme (refeeding) sendromu riski göz önünde bulundurularak beslenme kademeli artırılmalı ve elektrolit takibi titizlikle yapılmalıdır.
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