Controlled enteral nutrition in critical care patients-A randomized clinical trial of a novel management system

被引：9

作者：

Kagan, Ilya ^{[1
,2
]}

Hellerman-Itzhaki, Moran ^{[1
,2
]}

Bendavid, Itai ^{[1
,2
]}

Statlender, Liran ^{[1
,2
]}

Fishman, Guy ^{[1
,2
]}

Wischmeyer, Paul E. ^{[3
]}

de Waele, Elisabeth ^{[4
,5
,6
]}

Singer, Pierre ^{[1
,2
]}

机构：

[1] Tel Aviv Univ, Beilinson Hosp, Rabin Med Ctr, Dept Gen Intens Care, IL-49100 Petah Tiqwa, Israel

[2] Tel Aviv Univ, Beilinson Hosp, Rabin Med Ctr, Inst Nutr Res, IL-49100 Petah Tiqwa, Israel

[3] Duke Univ, Sch Med, DUMC, Dept Anesthesiol & Surg, Box 3094,Mail 41,2301 Erwin Rd,5692 HAFS, Durham, NC 27710 USA

[4] Univ Ziekenhuis Brussels, Dept Clin Nutr, Brussels, Belgium

[5] Univ Ziekenhuis Brussel, Dept Intens Care, Brussels, Belgium

[6] Vrije Univ Brussel, Pl Laan 2, B-1050 Brussels, Belgium

来源：

CLINICAL NUTRITION | 2023年 / 42卷 / 09期

关键词：

Enteral nutrition; Intensive care; Critical care; ICU outcome; Hospitalization; Malnutrition; ILL PATIENTS; INTENSIVE-CARE; RISK-FACTORS; FEEDING INTOLERANCE; PREVALENCE; OUTCOMES; VOLUME;

D O I：

10.1016/j.clnu.2023.06.018

中图分类号：

R15 [营养卫生、食品卫生]; TS201 [基础科学];

学科分类号：

100403 ;

摘要：

Purpose: Nutritional therapy is essential to ICU care. Successful early enteral feeding is hindered by lack of protocols, gastrointestinal intolerance and feeding interruptions, leading to impaired nutritional intake. smART+ was developed as a nutrition management feeding platform controlling tube positioning, reflux, gastric pressure, and malnutrition. This study evaluated the potential of this new ICU care platform to deliver targeted nutrition and improve ICU outcomes. Methods: Critically ill patients >18 years-old, mechanically ventilated and enterally fed, were randomized to receive ESPEN-guideline-based nutrition or smART+ -guided nutrition for 2-14 days. Primary endpoint was average deviation from daily targeted nutrition determined via calculation of energy targets per calorimetry. Secondary endpoints included gastric residual volumes, length of stay (LOS) and length of ventilation (LOV). Results: smART+ achieved a mean deviation from daily targeted nutrition of 10.5% (n = 48) versus 34.3% for control (n = 50), p < 0.0001. LOS and LOV were decreased in the smART+ group versus control (mean LOS: 10.4 days versus 13.7; reduction 3.3 days, adjusted HR 1.71, 95% CI:1.13,2.60, p = 0.012; mean LOV: 9.5 days versus 12.8 days reduction of 3.3 days, adjusted HR 1.64, 95% CI:1.08-2.51, p = 0.021). Feeding goals were met (within & PLUSMN;10%) on 75.7% of days for smART+ versus 23.3% for control (p < 0.001). No treatment-related adverse events occurred in either group. The study was stopped due to success in a planned interim analysis of the first 100 patients. Conclusion: The smART+ Platform improved adherence to feeding goals and reduced LOS and LOV versus standard of care in critically ill patients. Trial registration: NCT04098224; registered September 23, 2019. & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

引用

页码：1602 / 1609

页数：8