Abstract：
BACKGROUND: Critically ill surgical patients pose one of the greatest challenges in achieving nutritional goals. Several published papers have demonstrated clear benefits when nutrition support (NS) is managed by a multidisciplinary nutrition support team (NST). We hypothesized that implementing a NST in a surgical intensive care unit (ICU) would increase the number of patients achieving their nutritional goals.
METHODS: Multicenter \"BEFORE & AFTER\" study. In the BEFORE phase, an audit of the previous state of NS was conducted in three ICUs without a NST.
METHODS: Implementation of a NST and protocol. In the AFTER phase, a new audit of NS was conducted. Continuous variables (presented as mean ± SD or median Q1-Q3) were tested using the t-test and Mann-Whitney U test. Categorical variables (presented as frequencies and percentages) were assessed using the chi-square test. A binomial logistic regression model was performed, with independent variables introduced using a stepwise forward method. A difference was considered to be significant with a two-sided P-value <0.05. Statistical analysis was conducted using IBM-SPSS 26.
RESULTS: A total of 83 patients were included in the BEFORE phase, and 85 in the AFTER phase. The latter group showed a higher frequency of nutritional risk and malnutrition (SGA B+C odds ratio 2.314, 95% CI 1.164-4.600). Laparoscopy was more frequently utilized as a surgical technique in the AFTER phase. No differences were observed in ICU and hospital LOS or 90 days\' survival rates. Two variables remained independent factors to predict NS achievement: NST implementation (odds ratio 3.582, 95% CI 1.733-7.404), and surgical technique (odds ratio 3.231, 95% CI 1.312-7.959).
CONCLUSIONS: NST positively impacts the chance of achieving NS goals in critically ill surgical patients.
METHODS: Multicenter \"BEFORE & AFTER\" study. In the BEFORE phase, an audit of the previous state of NS was conducted in three ICUs without a NST.
METHODS: Implementation of a NST and protocol. In the AFTER phase, a new audit of NS was conducted. Continuous variables (presented as mean ± SD or median Q1-Q3) were tested using the t-test and Mann-Whitney U test. Categorical variables (presented as frequencies and percentages) were assessed using the chi-square test. A binomial logistic regression model was performed, with independent variables introduced using a stepwise forward method. A difference was considered to be significant with a two-sided P-value <0.05. Statistical analysis was conducted using IBM-SPSS 26.
RESULTS: A total of 83 patients were included in the BEFORE phase, and 85 in the AFTER phase. The latter group showed a higher frequency of nutritional risk and malnutrition (SGA B+C odds ratio 2.314, 95% CI 1.164-4.600). Laparoscopy was more frequently utilized as a surgical technique in the AFTER phase. No differences were observed in ICU and hospital LOS or 90 days\' survival rates. Two variables remained independent factors to predict NS achievement: NST implementation (odds ratio 3.582, 95% CI 1.733-7.404), and surgical technique (odds ratio 3.231, 95% CI 1.312-7.959).
CONCLUSIONS: NST positively impacts the chance of achieving NS goals in critically ill surgical patients.
摘要：
背景：重症手术患者在实现营养目标方面面临的最大挑战之一。几篇发表的论文已经证明，当多学科营养支持团队（NST）管理营养支持（NS）时，有明显的益处。我们假设在外科重症监护病房（ICU）实施NST将增加实现营养目标的患者人数。
方法：多中心“之前和之后”研究。在前阶段,在没有NST的三个ICU中对NS的先前状态进行了审核。
方法：NST和协议的实现。在后阶段,对NS进行了新的审计。使用t检验和Mann-WhitneyU检验对连续变量(以平均值±SD或中值Q1-Q3表示)进行检验。使用卡方检验评估分类变量(以频率和百分比表示)。进行了二项逻辑回归模型，使用逐步前向方法引入自变量。在双侧P值<0.05的情况下,认为差异是显著的。使用IBM-SPSS26进行统计分析。
结果：共有83名患者被纳入BEFORE阶段，85后阶段。后者表现出更高的营养风险和营养不良的频率（SGABC比值比2.314，95％CI1.164-4.600）。在AFTER阶段，腹腔镜检查更经常用作手术技术。在ICU和医院LOS或90天生存率中没有观察到差异。两个变量仍然是预测NS成就的独立因素：NST实施(赔率比3.582，95%CI1.733-7.404)，和手术技术（比值比3.231，95%CI1.312-7.959）。
结论：NST对危重手术患者实现NS目标的机会有积极影响。
方法：多中心“之前和之后”研究。在前阶段,在没有NST的三个ICU中对NS的先前状态进行了审核。
方法：NST和协议的实现。在后阶段,对NS进行了新的审计。使用t检验和Mann-WhitneyU检验对连续变量(以平均值±SD或中值Q1-Q3表示)进行检验。使用卡方检验评估分类变量(以频率和百分比表示)。进行了二项逻辑回归模型，使用逐步前向方法引入自变量。在双侧P值<0.05的情况下,认为差异是显著的。使用IBM-SPSS26进行统计分析。
结果：共有83名患者被纳入BEFORE阶段，85后阶段。后者表现出更高的营养风险和营养不良的频率（SGABC比值比2.314，95％CI1.164-4.600）。在AFTER阶段，腹腔镜检查更经常用作手术技术。在ICU和医院LOS或90天生存率中没有观察到差异。两个变量仍然是预测NS成就的独立因素：NST实施(赔率比3.582，95%CI1.733-7.404)，和手术技术（比值比3.231，95%CI1.312-7.959）。
结论：NST对危重手术患者实现NS目标的机会有积极影响。
