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. 2019 May 7;9(1):53.
doi: 10.1186/s13613-019-0527-6.

Impact of a computer-assisted decision support system (CDSS) on nutrition management in critically ill hematology patients: the NUTCHOCO study (nutritional care in hematology oncologic patients and critical outcome)

Florence Ettori  1 , Aurélia Henin  1 , Christophe Zemmour  2   3 , Laurent Chow-Chine  1 , Antoine Sannini  1 , Magali Bisbal  1 , Frédéric Gonzalez  1 , Luca Servan  1 , Jean Manuel de Guibert  1 , Marion Faucher  1 , Jean Marie Boher  2   3 , Djamel Mokart  4
Affiliations

Impact of a computer-assisted decision support system (CDSS) on nutrition management in critically ill hematology patients: the NUTCHOCO study (nutritional care in hematology oncologic patients and critical outcome)

Florence Ettori et al. Ann Intensive Care. .

Abstract

Background: 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.

Results: 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.

Conclusion: 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.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Paoli-Calmettes Institute Institutional Review Board, and since there was no interference with patients’ management, signed informed consent was waived.

Consent for publication

Not applicable.

Competing interests

All authors declare no competing interests. Fresenius Kabi was not involved in any aspect of the design or conduct of the study, the data analysis, or the manuscript preparation and presentation.

Figures

Fig. 1
Fig. 1
Hospital survival according to the use of CDSS (after group) for overall population
Fig. 2
Fig. 2
Reasons for oral and enteral nutrition failure in the ‘after group.’ ARF acute respiratory failure
See this image and copyright information in PMC

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