Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
Acta Anaesthesiol Scand. 2024 Nov;68(10):1487-1493. doi: 10.1111/aas.14531. Epub 2024 Sep 29.
A careful approach is required when providing nutritional support to patients with acute respiratory distress syndrome (ARDS). This study investigated whether implementing a multidisciplinary nutritional support team (NST) is associated with improved survival outcomes in patients with ARDS.
In a nationwide population-based cohort study, all adult patients admitted to the intensive care unit (ICU) in South Korea with a primary diagnosis of ARDS from January 1, 2017, to December 31, 2021, were included. The NST comprised four professionals (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). Patients admitted to ICUs with and without the NST system were allocated to the NST and non-NST groups, respectively.
The analysis comprised a total of 15,555 patients with ARDS. Among them, 6615 (42.5%) were in the NST group, and 8940 (57.5%) were in the non-NST group. After adjusting for covariates in the multivariable logistic regression, the NST group showed a 19% lower 30-day mortality than the non-NST group (odds ratio: 0.81, 95% confidence interval: 0.75-0.87, p < .001). Furthermore, after adjusting for covariates in multivariable Cox regression, the NST group showed a 12% lower 1-year all-cause mortality than the non-NST group (hazard ratio: 0.88, 95% confidence interval: 0.85-0.92, p < .001).
NST implementation was associated with enhanced 30-day and 1-year survival rates in patients with ARDS. These findings indicate that nutritional support provided by the NST may influence the survival outcomes of patients with ARDS in the ICU.
在为急性呼吸窘迫综合征（ARDS）患者提供营养支持时需要谨慎。本研究旨在探讨多学科营养支持小组（NST）的实施是否与 ARDS 患者的生存结局改善相关。
在一项全国性基于人群的队列研究中，纳入了 2017 年 1 月 1 日至 2021 年 12 月 31 日期间在韩国重症监护病房（ICU）因 ARDS 初诊而入院的所有成年患者。NST 由四名专业人员（医生、全职护士、全职药剂师和全职临床营养师）组成。入住有和无 NST 系统的 ICU 的患者分别被分配到 NST 组和非 NST 组。
共纳入 15555 例 ARDS 患者。其中，6615 例（42.5%）患者在 NST 组，8940 例（57.5%）患者在非 NST 组。在多变量逻辑回归中调整协变量后，NST 组的 30 天死亡率比非 NST 组低 19%（优势比：0.81，95%置信区间：0.75-0.87，p<.001）。此外，在多变量 Cox 回归中调整协变量后，NST 组的 1 年全因死亡率比非 NST 组低 12%（风险比：0.88，95%置信区间：0.85-0.92，p<.001）。
NST 的实施与 ARDS 患者的 30 天和 1 年生存率的提高有关。这些发现表明，NST 提供的营养支持可能会影响 ICU 中 ARDS 患者的生存结局。
