Z Gastroenterol 2009; 47 - A82
DOI: 10.1055/s-0029-1224061

Parenteral nutrition support: Is there a chance beyond intensive care units?

P Sahin 1, J Futó 2, J Bajor 3, C Molnár 4, G Kriván 5, A Fenyvesi 6, J Hamvas 7, C Rédei 1, A Aradán 1, L Topa 1
  • 1Department of Gastroentrology, St. Imre Hospital, Budapest
  • 2Casualty Department, Central Operating Theatre and Anaesthesiology Service, St. Imre Hospital. Budapest
  • 3Department of Medicine and Gastroenterology, Baranya Country of Hospital
  • 4Department of Gastroenterology, Jávorszky Ödön Hospital, Vác
  • 5Department of Pediatric Hematology and Stem Cell Transplantation, St. László Hospital, Budapest
  • 6Department of Gastroenterology, Yahn Ferenc Hospital, Budapest
  • 7Department of Gastroenterology, Bajcsy Zsilinszky Hospital, Hungary

Introduction: It is necessary to feed patients (pts) suffering from intestinal failure originated from short bowel syndrome (SBS). In Hungary, we should treat around 100–200 pts yearly, but this doesn't occur partly because of the legal and organizational difficulties and partly because of the imperfect medical attitude.

Aim: We present how it is still possible to realize long term parenteral nutrition (PN) in general hospital units or as an ambulant health provision.

Patients, methods: We treated 3 pts with functional and 4 pts with anatomic SBS in the last 10 years. In ambulant cases the PN was accomplished in hospital or at home. We administrated all-in-one parenteral solutions with additional nutrients daily or nightly in 12 hours. Energy requirement was calculated and later modified according to real demand. Nutritional status was controlled monthly.

Results: We have been treating our first SBS patient- operated for benign tumor-for 10 years. Her body mass index (BMI) is 19. We have been treating our second patient-operated for malignant gynecological tumor then reoperated because of adhesions – having a small bowel stoma for 2 years. Her BMI is 20. Our third patient had an operation for a benign gynecological disease, then a reoperation because of adhesions. Her BMI is 20. We have been treating 2 pts suffering from common variable immune deficiency with enteral nutrition and intermittently PN. Their BMI is 16–17!. Two of our pts are able to administrate the PN themselves. These 2 pts had been provisionally nourished partly at home, illegally. We lost 2pts.

Conclusion: At present, no sufficient conditions to administrate PN to pts exist in hospitals outside intensive care units or at home and the adequate attitude is still missing. The home parenteral nutrition (HPN) could be safely accomplished with a professionally convenient and committed patient-education, but the legal terms are still absent. The pts' fixity to the hospital worsens their quality of life. The individual financing of the PN is complicated. Regarding these facts, it is urgent in Hungary to introduce and apply HPN.