From the creation to the appreciation of a personal digital assistant-based clinical decision-support system for the management of artificial nutrition

Objectives.-The aim of our study was to assess the effect of NutriPDA, a personal digital assistant (PDA)-based clinical decision-support system (CDSS) for the management of artificial nutrition. A CDSS was developed and implemented on a handheld computer for use in the ICU after cardiovascular and thoracic surgery. Study design.-System impact was assessed in a prospective "before/after" cohort trial. Methods.-After informed consent we studied 61 patients in the postcardiovascular and thoracic surgery ICU (age > 17 years, duration of artificial nutrition > 3 days, length of stay > 8 days). Patients were divided into two groups (before and after the use of NutriPDA: Group A: 32 patients (4-month period in 2005); group B: 29 patients (4-month period in 2006). Results.-There were no significant differences in anthropometric and clinical parameters between the 2 groups. Energetic intakes were < 80% of basal energetic expenditures in 21 % and 1 % of patients, respectively (P < 0.01). Caloric and nitrogen intakes were below international recommendation in Group A: 20 +/- 4 kcal/kg/d (mean +/- SD), 104 +/- 30, mg/kg/d, but not in Group B: 26 +/- 5 kcal/kg/d, 196 +/- 41 mg/kg/d (P < 0.01). Conclusion.-NutriPDA was found to be able to optimize artificial nutrition by improving caloric intake in ICU. This new software has potential clinical applications. (C) 2007 Elsevier Masson SAS. Tous droits reserves.