Impact de l’utilisation systématique d’un arbre décisionnel pour la nutrition entérale en réanimation

The management of enteral nutrition in intensive care requires a systematic and pluridisciplinary approach, including the use of decision trees adapted to the local constraints for the initiation, the adaptation of infusion rates and the management of the frequent complications. We analysed the effects of the implementation of a decision tree available at bedside on a cohort of 40 consecutive patients who received an exclusive enteral nutrition for at least 4days. The patients of the group PRE (n=20) and of the group POST (n=20) respectively stayed in the intensive care unit before and after the diffusion of the decision tree. The effects of the implementation of the decision tree on the delay before initiation of enteral nutrition, on the difference between the actual and the recommended prescription, and the differences between target rate and the actual caloric intake were compared between the groups. The patients of the groups PRE and POST were similar (severity score APACHE II on admission [12.2±3.9 versus 14.5±6.3], age [60 (48–64) versus 62 (48–78) years], body mass index [25±26 versus 24±24] and proportion of females [50% versus 40%]). The total number of days of observation was 326 (204days for the group PRE and 122days for the group POST). As compared to the group PRE, the time between admission and the initiation of enteral nutrition, and the difference between the actual and the recommended prescription tended to decrease in the group POST. The time needed to achieve the target rate was shorter during the period POST (P