Groundbreaking clinical study data shows the smART+ Platform reduces ICU length of stay and length of ventilation by more than 3 days

Controlled enteral nutrition in critical care patients –
A randomized clinical trial of a novel management system

Comparative, prospective, stratified randomized study
Dr. Ilya Kagan MD, Dr. Moran Hellerman-Itzhaki MD, Dr. Itai Bendavid MD, Dr. Liran Statlender MD, Dr. Guy Fishman MD, Prof. Paul E Wischmeyer MD PhD, Prof. Elisabeth de Waele MD PhD, Prof. Pierre Singer MD

Setting a new benchmark in critical care nutrition
FEEDING EFFICIENCY*
89.5% vs. 65.7%

P-Value < 0.0001
* Delivered nutrition / Target nutrition

LENGTH OF ICU STAY
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3.3 DAYS REDUCTION

HR 1.71, 95% CI: 1.13-2.60, p = 0.012
From 13.7 days to 10.4 days

LENGTH OF VENTILATION
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3.3 DAYS REDUCTION

HR 1.64, 95% CI: 1.08-2.51, p = 0.021
From 12.8 days to 9.5 days

REACHING NUTRITIONAL TARGETS
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10X MORE EFFICIENT THAN STANDARD PROTOCOLS
  • Stratified randomization: according to APACHE score (T=22.4 vs. C=22.32)
  • Patient population: 85% medical patients
The smART+ Platform vs Standard-of-Care ESPEN-based Feeding Protocols

The study demonstrates that the smART+ Platform can significantly improve feeding efficiency versus standard-of-care ESPEN-based feeding protocols. The system is designed to prevent delayed initiation of enteral feeding by assisting in tube positioning, continuously calculating an appropriate energy goal, and supporting the physician in selecting the right feeding formula. To offset feeding interruptions, the system calculates the resulting deficit and delivers gradual compensation so that planned nutrition is delivered close to 90%.

 

There are several causes and negative consequences of inadequate enteral intake. Factors causing inadequate enteral nutritional intake include:

  • delayed initiation of enteral feeding
  • slow increase in reflux rate
  • under-prescription
  • incomplete delivery of planned nutrition
  • frequent interruptions of the feeding process

Key findings:
The management of enteral feeding using a controlled management system may be beneficial to reduce the risks of aspiration. This may explain the significant 3.3 days reduction in LOS and LOV observed in the study group.

  • Improvements in gastric tolerance. The smART+ Platform improves gastric tolerance over control, and an association has been identified between feeding intolerance (FI) and increased LOS and LOV among 22 studies subject to a systematic review.
  • Reduced VAE incidence. The reduction in LOS and LOV was associated with decreases in the incidence of VAE for the system versus control. Micro-aspiration of gastric contents is a frequent consequence of reflux and may increase the risks of larger-scale aspiration and extend LOV.
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With the smART+ Platform, we are now able to provide prescribed and adequate enteral feeding to patients daily. This has never been possible before. smART+ is truly a breakthrough technology that will profoundly impact the practice of critical care nutrition going forward.

Prof. Pierre Singer Former Chairman of ESPEN

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