August 10, 2023
4 minute read
Disclosure: ART MEDICAL funded this study. Singer has received grants from ART MEDICAL, Baxter, B Braun, Fresenius Kabi, Mindray and Nestle, and reports that he has received options for a limited stock of value commensurate with ART MEDICAL’s consulting services. . See this study for relevant financial disclosures of all other authors.
- A robot-guided smART+ platform and manual care of enteral nutrition demonstrated higher nutritional efficiency.
- Patients in the smART+ group spent fewer days on ventilation in the ICU.
Compared to manual care for enterally-fed ICU patients, a robot-guided nutrition management platform achieved nutritional goals more frequently and reduced length of stay and ventilation duration, according to results published in It is said that it was done. clinical nutrition.
According to the researchers, the smART+ platform (ART MEDICAL) is a robotic guidance tool that can control “tube position, reflux, gastric pressure and malnutrition” to ensure timely enteral feeding.
“Nutrition has been neglected in the ICU for many years.” Pierre Singermedical doctor, General Intensive Care Director and Director of the Institute of Nutrition at Rabin Medical Center told Helio. “There have been no advances in monitoring tools or new technologies, and no studies demonstrating significant benefits, so the impact of this comparative study should be significant.”
“This is a breakthrough in enteral nutrition technology,” added Singer. “For 40 years it was very low-tech. It involved a pump that suspended a bag of liquid milk and pushed out a certain amount of energy/protein depending on the rate/dosage during the ICU stay.”
In a randomized clinical trial, Singer et al. analyzed 98 mechanically ventilated and enterally fed adults in the ICU, with patients receiving smART+ nutritional counseling (n = 48), and Differences in feeding effects were assessed between patients receiving the indicated standard/manual care. He from 2 to 14 days according to the European Society of Clinical Nutrition and Metabolism guidelines (n = 50).
The investigators also sought to find differences between groups with respect to gastric residual volume, ICU duration, and duration of ventilation.
“Routine practice in the ICU can result in failure to meet daily energy and protein goals, resulting in nutritional deficiencies,” Singer told Helio. “Clinical consequences are decreased energy balance, nitrogen balance, increased risk of infection, increased ICU length of stay and duration of ventilation.”
Compared with patients receiving standard manual feeding, patients receiving smART+ guided feeding had a mean reduction from daily target nutrition (energy target per calorimetry; 10.5% vs. 34.3%) With low deviation, the smART+ group showed a feeding efficacy of 89.5% versus an efficacy of 65%. Belongs to manual care group.
“this [result] This means that starting today, you can meet your energy and protein goals despite all the obstacles you encountered while traveling in the ICU,” Singer said.
During the study period, patients on the smART+ platform were within 90% to 110% of their nutritional goals 75.7% of the days, whereas those on standard of care met this goal. Only 23.3% of the days it was possible (P. < .0001). In addition, major deviations from eating goals (>140% or <60%) occurred on 29.1% of days in the standard care group, compared with 4.8% in the smART+ group. It was only on the day of
According to the researchers, overfeeding was more common in the standard care and smART+ groups (13 patients vs. 1 patient), and these patients were consuming 33.7% more than their target, whereas Patients in the smART+ group exceeded the target by 2.7%.
Although underfeeding was more common in patients receiving smART+ platform feeding (47 patients vs. 37 patients), the researchers found that the degree of underfeeding based on these patients’ goals was We found that it was smaller compared to patients receiving therapeutic nutrition (10.6% below target vs. 34.5% below target).
ICU stay time, ventilation time, safety
Patients in the smART+ group also spent fewer days in the ICU (mean, 10.4 vs. 13.7 days, aHR = 1.71, 95% CI, 1.13-2.6) and fewer days on a ventilator (mean, 9.5 days vs. 12.8 days, aHR = 1.64). ; 95% CI, 1.08-2.51), which was unexpected, Singer told Healio.
“Although we know that gastrointestinal intolerance is associated with longer hospital stays, this study suggests that hospital stays may be shortened if enteral feeding can be adapted according to gastrointestinal tolerance. suggests,” he said. “Of course, this needs to be confirmed by further research.”
Another surprising finding, Singer said, is that the smART+ nasogastric tube sensor can detect reflux events and monitor gastric function.
“As a result, the study group had significantly less gastric residue, while the control group required more antiperistaltic,” he said. “According to the tolerance of the stomach, the platform was able to adapt itself to itself and provide enteral feeding only when it was well tolerated. You can compare it to your respiratory system.”
In addition, patients in the smART+ group used the nausea and vomiting drug metoclopramide for an average of only 2 days, compared to 25 days for patients in the standard care group.
Of note, neither group of patients reported treatment-related adverse events, and ICU mortality did not differ between groups.
This new nutrition management platform overcomes many challenges to enteral feeding, Singer said.
“The smART+ platform offers a holistic solution to overcome many obstacles that are typically unsolvable in everyday practice,” Singer told Healio. “First, it measures and assesses your energy needs. Second, it helps your doctor prescribe according to your energy protein goals. Third, your nutritional goals are met. If the platform is used in routine ICU practice, the management of enteral nutrition will become efficient and safe, and medical nutrition therapy will be recognized.”
Singer also told Healio that the platform is a “game changer” for future research.
“To date, most studies have used predictive equations to determine energy targets, mostly showing success rates of up to about 60% in delivering this energy,” he said. rice field. “Such an approach is unacceptable when talking about antibiotic therapy. With the smART+ platform, studies are targeted and comparisons between high- and low-energy goals, for example, are much more acceptable. In addition, new tools for detecting reflux phenomena and managing enteral nutrition are being further investigated, for example, to better define gastric tolerance and patient tolerance of specific enteral products for specific conditions. should.”
As for the future of the smART+ platform, Singer expects it to be widely adopted.
“The future of this platform is that it will be integrated around ICU patient beds,” Singer said. “The accumulated data can be used to more accurately predict patient response using machine learning. This is an important step towards personalized nutrition. Being able to prescribe therapy and provide optimal treatment with minimal complication rates is a clear advantage.The integration of this technology into complex systems is another challenge that will be addressed in the future. It’s one challenge.”