Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel.
Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, University of Tel Aviv, Petah TIkva 49100, Israel.
Clin Nutr. 2023 Sep;42(9):1602-1609. doi: 10.1016/j.clnu.2023.06.018. Epub 2023 Jul 7.
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.
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).
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 ±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.
The smART+ Platform improved adherence to feeding goals and reduced LOS and LOV versus standard of care in critically ill patients.
NCT04098224; registered September 23, 2019.
营养治疗是 ICU 护理的基础。由于缺乏方案、胃肠道不耐受和喂养中断，早期肠内喂养难以成功，导致营养摄入受损。smART+ 是一种作为营养管理的喂养平台，可控制管定位、反流、胃压和营养不良。本研究评估了这种新的 ICU 护理平台输送靶向营养和改善 ICU 结果的潜力。
≥18 岁、机械通气和肠内喂养的危重症患者，随机接受 ESPEN 指南指导的营养或 smART+ 指导的营养治疗 2-14 天。主要终点是通过计算每卡路里的能量目标来确定每日目标营养的平均偏差。次要终点包括胃残留量、住院时间 (LOS) 和通气时间 (LOV)。
smART+ 实现了每日目标营养的平均偏差为 10.5%（n=48），而对照组为 34.3%（n=50），p<0.0001。smART+ 组的 LOS 和 LOV 较对照组降低（平均 LOS：10.4 天与 13.7 天，减少 3.3 天，调整后的 HR 为 1.71，95%CI：1.13，2.60，p=0.012；平均 LOV：9.5 天与 12.8 天，减少 3.3 天，调整后的 HR 为 1.64，95%CI：1.08-2.51，p=0.021）。smART+ 组有 75.7%的天数满足喂养目标（在±10%范围内），而对照组为 23.3%（p<0.001）。两组均未发生与治疗相关的不良事件。由于对前 100 名患者的计划中期分析取得成功，该研究提前停止。
与标准治疗相比，smART+ 平台提高了对喂养目标的依从性，并降低了危重症患者的 LOS 和 LOV。
NCT04098224；2019 年 9 月 23 日注册。
