Ettori Florence, Henin Aurélia, Zemmour Christophe, Chow-Chine Laurent, Sannini Antoine, Bisbal Magali, Gonzalez Frédéric, Servan Luca, de Guibert Jean Manuel, Faucher Marion, Boher Jean Marie, Mokart Djamel
Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France.
Unité de Biostatistique et de Méthodologie, Institut Paoli-Calmettes, Marseille, France.
Ann Intensive Care. 2019 May 7;9(1):53. doi: 10.1186/s13613-019-0527-6.
Mortality of critically ill hematology (HM) patients has improved over time. Thus, those patients require an extensive diagnostic workup and the optimal use of available treatments. There are no data regarding nutrition strategy for critically ill HM patients, while nutritional support is crucial for both HM and critically ill patients. We hypothesized that the implementation of a computer-assisted decision support system (CDSS), designed to supervise a nutritional intervention by a multidisciplinary team, would be able to increase guidelines adherence and outcomes.
In this before/after study, 275 critically ill hematology patients admitted to the ICU over 5-year period were included. Energy and protein intakes were delivered using standard protocol in the 147 patients (53%) of the 'before group' and using a CDSS in order to reach every day predefined caloric and protein targets accordingly to the catabolic or anabolic status in the 128 patients (47%) of the 'after group.' Using a Poisson regression, we showed that the use of CDSS allowed to reach a relative increase in the rate of days in compliance with caloric (1.57; 95% confidence interval (CI), [1.17-2.10], p = 0.0025) and protein targets (3.86 [2.21-6.73], p < 0.0001) in the 'after group' by more than 50% as compared with the 'before group.' Interestingly, compliance rates were low and only reached 30% after intervention. Hospital mortality, ICU-acquired infection, and hospital, and ICU length of stay were similar in the two groups of patients. Importantly, exploratory analysis showed that hospital mortality was lower in the 'after group' for neutropenic and severely ill patients.
For critically ill hematology patients, the use of a nutritional CDSS allowed to increase the days in compliance with caloric and protein targets as compared with no CDSS use. In this context, overall hospital mortality was not affected.
重症血液学（HM）患者的死亡率随时间推移有所改善。因此，这些患者需要广泛的诊断检查以及对现有治疗方法的优化使用。目前尚无关于重症HM患者营养策略的数据，而营养支持对HM患者和重症患者都至关重要。我们假设，实施一个旨在监督多学科团队营养干预的计算机辅助决策支持系统（CDSS），将能够提高指南依从性并改善治疗结果。
在这项前后对照研究中，纳入了5年间入住重症监护病房（ICU）的275例重症血液学患者。“前组”的147例患者（53%）按照标准方案提供能量和蛋白质摄入，“后组”的128例患者（47%）使用CDSS，以便根据分解代谢或合成代谢状态达到每日预先设定的热量和蛋白质目标。通过泊松回归分析，我们发现使用CDSS使得“后组”达到热量目标的天数比例相对增加（1.57；95%置信区间[CI]，[1.17 - 2.10]，p = 0.0025），达到蛋白质目标的天数比例相对增加（3.86 [2.21 - 6.73]，p < 0.0001），与“前组”相比增加超过50%。有趣的是，依从率较低，干预后仅达到30%。两组患者的医院死亡率、ICU获得性感染以及住院时间和ICU住院时间相似。重要的是，探索性分析表明，“后组”中中性粒细胞减少和重症患者的医院死亡率较低。
对于重症血液学患者，与不使用CDSS相比，使用营养CDSS可增加达到热量和蛋白质目标的天数。在此背景下，总体医院死亡率未受影响。
