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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition

医学 肠外营养 重症监护医学 队列 梅德林 指南 随机对照试验 病危 肠内给药 分级(工程) 医学营养疗法 临床试验 临床营养学 队列研究 儿科 内科学 土木工程 病理 政治学 法学 工程类
作者
Nilesh M. Mehta,Heather E. Skillman,Sharon Y. Irving,Jorge Coss-Bu,Sarah Vermilyea,Elizabeth Farrington,Liam McKeever,Amber M. Hall,Praveen S. Goday,Carol L. Braunschweig
出处
期刊:Journal of Parenteral and Enteral Nutrition [Wiley]
卷期号:41 (5): 706-742 被引量:242
标识
DOI:10.1177/0148607117711387
摘要

This document represents the first collaboration between 2 organizations—the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine—to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and <18 years) expected to require a length of stay >2–3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment—particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.
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