[Nutrition in critical illness]. / A kritikus állapotú betegek táplálása.

Critically ill patients are often unable to eat by themselves over a long period of time, sometimes for weeks. In the acute phase, serious protein-energy malnutrition may develop with progressive muscle weakness, which may result in assisted respiration of longer duration as well as longer stay in intensive care unit and hospital. In view of the metabolic processes, energy and protein intake targets should be defined and the performance of metabolism should be monitored. Enteral nutrition is primarily recommended. However, parenteral supplementation is often necessary because of the disrupted tolerance levels of the gastrointestinal system. Apparently, an early parenteral supplementation started within a week would be of no benefit. Some experts believe that muscle loss can be reduced by increased target levels of protein. Further studies are needed on the effect of immune system feeding, fatty acids and micronutrients.

The attitude and knowledge of intensive care physicians and nurses regarding organ donation in Hungary--it needs to be changed.

BACKGROUND: The education of intensive care professionals can influence the number of transplantable organs. The aim of this cross-sectional study is to estimate the attitude and knowledge of intensive care staff as about organ donation. MATERIAL/METHODS: The self-completed questionnaire was completed at the Congress of the Hungarian Society of Anesthesiology and Intensive Therapy in 2011. Data, including attitudes about donation, attendance in an organ donation course, donation activity, self-reported knowledge of donor management, legislation, transplantation, and aftercare were collected from intensive care specialists (n=179) and nurses (n=103). RESULTS: An organ donation course was attended by 53.6% of physicians and 16.7% of nurses (p=0.000); the 59% of doctors and 64.7% of nurses who did not participate in education were not willing to do so. Older staff were more likely to attend the course (p<0.01). Organ donation activity was not influenced by age or type of staff (physician or nurse), but it was higher among staff who attended training (p<0.01). Independently from accepting the presumed consent legislation (91.1%), 66% of intensive care professionals supported the practice of requesting the consent of family for organ retrieval. Self-reported knowledge regarding the Eurotransplant, donor management, the law and ethics of donation, transplantation, and after care for transplanted patients was influenced by age, donation activity, education, type of staff (p<0.01). CONCLUSIONS: Education, including knowledge concerning brain death, donor management and communication with family, needs to be part of the specialist training of intensive care professionals, with a refresher course every fifth year.

[Principles of intensive care in severe acute pancreatitis in 2008]. / Az akut súlyos pancreatitis intenzív terápiás kezelési elvei 2008-ban.

Acute pancreatitis is a dynamic, often progressive disease; 14-20% require intensive care in its severe form due to multiorgan dysfunction and/or failure. This review was created using systematic literature review of articles published on this subject in the last 5 years. The outcome of severe acute pancreatitis is determined by the inflammatory response and multiorgan dysfunction - the prognostic scores (Acute Physiology and Chronic Health Evaluation, Glasgow Prognostic Index, Sepsis-related Organ Failure Assessment, Multi Organ Dysfunction Syndrome Scale, Ranson Scale) can be used to determine outcome. Clinical signs (age, coexisting diseases, confusion, obesity) and biochemistry values (serum amylase, lipase, C-reactive protein, procalcitonin, creatinine, urea, calcium) have important prognostic roles as well. Early organ failure increases the risk of late abdominal complications and mortality. Intensive care can provide appropriate multi-function patient monitoring which helps in early recognition of complications and appropriate target-controlled treatment. Treatment of severe acute pancreatitis aims at reducing systemic inflammatory response and multiorgan dysfunction and, on the other side, at increasing the anti-inflammatory response. Oral starvation for 24-48 hours is effective in reducing the exocrine activity of the pancreas; the efficacy of protease inhibitors is questionable. Early intravascular volume resuscitation and stable haemodynamics improve microcirculation. Early oxygen therapy and mechanical ventilation provide adequate oxygenation. Electrolyte and acid-base control can be as important as tight glucose control. Adequate pain relief can be achieved by thoracic epidural catheterization. Early enteral nutrition with immunonutrition should be used. There is evidence that affecting the coagulation cascade by activated protein C can play a role in reducing the inflammatory response. The complex therapy of acute pancreatitis includes appropriate antibiotics, thrombo-embolic prophylaxis and in certain cases plasmapheresis and/or haemofiltration. Reducing intraabdominal pressure may be necessary in the acute phase. Intensive care multidisciplinary teamwork can reduce the mortality of severe acute pancreatitis from 30% to 10%.

[Comparative analysis in artificial nutrition]. / A mesterséges táplálás helyzetének összehasonlító elemzése.

INTRODUCTION: It is well known to Hungarian experts in the field of nutrition that hospital inpatients in this country do not have the required nutrition. AIM: To compare data of intensive care national costing analysis from England and intensive care unit in County Hospital, Eger, Hungary in order to advise a cost effective nutrition protocol. METHOD: English data were extracted from the report of Intensive Care National Cost Block Programme, year 1999. The Hungarian data were obtained by top down method from annual costing report of the same year. The authors used Purchasing Power Parity to make international cost comparison between these countries. RESULTS: In proportion to Purchasing Power Parity, the hospital budget per patient for nutrition is more than double in England than in the studied intensive care unit in Hungary. Intensive care units in England spend 1% on nutrition, 13% on drugs and 10% on disposables. There is only 0.2% spent on nutrition, 29.8% on drugs and 8% on disposables in the studied intensive care unit in Hungary. Cost of nutrition per patient day is HUF 117 in Hungary, which is even lower than the hospital budget per patient day for nutrition. CONCLUSION: On the basis of the above findings and literature review as well, the authors set up a cost effective nutrition guideline: 1. Identify malnourished patient. 2. Nutrition can be delayed for 4-5 days in not malnourished patient. 3. Enteral nutrition should always be the first choice. 4. Total parenteral nutrition is beneficial only if given over at least 7 days. 5) It is cost effective to prevent nosocomial infections even at higher cost.