Evaluation of the quality of evidence supporting guideline recommendations for the nutritional management of critically ill adults

Xu, Elena; Solé-Lleonart, Candela; Campogiani, Laura; Valenzuela-Sánchez, Francisco; Koulenti, Despoina; Rello, Jordi

doi:10.1016/j.clnesp.2020.07.004

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…As identified when writing the recommendations, the European Society for Clinical Nutrition and Metabolism strongly recommends the combined use of physical diagnostic criteria and nutritional screening to identify the degree of malnutrition or cachexia in patients, despite a ‘very low’ level of available evidence for these tools. 45 The guidance in medical literature emphasises prevention (through the early identification of at-risk patients) (recommendation 3.5.2). 45 Whenever possible, the Primary Consensus Panel recommended that collaboration between expert nutritionists and physical therapists should be encouraged, to help patients maintain muscle strength, physical functioning and metabolic activity (recommendation 3.5.3); these later goals were widely endorsed by voters.…”

Section: Discussionmentioning

confidence: 99%

“… 45 The guidance in medical literature emphasises prevention (through the early identification of at-risk patients) (recommendation 3.5.2). 45 Whenever possible, the Primary Consensus Panel recommended that collaboration between expert nutritionists and physical therapists should be encouraged, to help patients maintain muscle strength, physical functioning and metabolic activity (recommendation 3.5.3); these later goals were widely endorsed by voters.…”

Section: Discussionmentioning

confidence: 99%

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Consensus recommendations on holistic care in hereditary ATTR amyloidosis: an international Delphi survey of patient advocates and multidisciplinary healthcare professionals

Obici,

Callaghan,

Ablett

et al. 2023

BMJ Open

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BackgroundHereditary transthyretin-mediated amyloidosis is a rare, progressive and potentially life-limiting multisystem disease, affecting every aspect of a patient’s life.ObjectivesThis online international Delphi survey aimed to evolve clinical−patient-led practical guidance, to inspire and encourage a holistic approach to care that is managed in specialist settings by multidisciplinary teams and supported by allied healthcare professionals (HCPs) and patient advocacy groups (PAGs).DesignA 14-member joint patient advocate−HCP primary panel was convened including representation from PAGs and key clinical specialties (neurology, cardiology, internal medicine, physiotherapy, clinical psychology, dietetics and specialist nursing). Guidance evolved on the care provision needed to support seven core goals: early diagnosis and treatment; disease monitoring and organisation of care; maintenance of physical and mental health; family-centred care and caregiver support; patient−doctor dialogue; access to social support and social networking.ParticipantsFrom June to October 2022, 252 HCPs and 51 PAG representatives from 27 countries were invited to participate in a Delphi survey. Of the 122 respondents who answered at least one survey question, most were HCPs (100, 82%) from specialist centres; the remainder were PAG representatives (22, 18%).Main outcome measureBoth level of agreement and feasibility in practice of each recommendation was tested by two anonymised online Delphi voting rounds.ResultsBased on an a priori threshold for consensus of ≥75% agreement, the clinical–patient community endorsed all but one recommendation. However, only 17/49 (35%) recommendations were identified by most HCPs as a core part of routine care; the remainder (32/49 (65%)) were identified as part of core care by <50% of HCPs respondents, or as largely achievable by 30%–45% of HCPs. By comparison, PAGs recorded lower implementation levels.ConclusionsFurther consideration is needed on how to evolve multidisciplinary services (supported by allied HCPs and PAGs) to address the complex needs of those affected by this disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Consensus recommendations on holistic care in hereditary ATTR amyloidosis: an international Delphi survey of patient advocates and multidisciplinary healthcare professionals

Obici,

Callaghan,

Ablett

et al. 2023

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Second, our literature languages were restricted to German and English and the search terms were also limited due to a large number of studies. Published guideline recommendations for the management of nutrition in ICU patients remain largely supported by expert opinion and only a minority of the studies and reports includes high-quality evidence [77]. Finally, few of the identified studies addressed the risks and safety issues of EN directly, therefore further research is needed.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

et al. 2020

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Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

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“…Two main concerns arise regarding nutrition in ECLS patients: the quality of the evidence is low, and guidelines do not provide specific treatment adapted to this setting. Xu et al graded the quality of evidence used to justify the ESPEN and ASPEN guidelines and found that the majority (52%) were based on the clinical experience of those who created the recommendation 9 . Thus, the nutrition approach is often left to personal beliefs, the discretion of the attending personnel, or is determined by local logistical practices, despite data evidencing that a correct and adequate nutritional support may contribute to early recovery and better quality of life post‐ICU stay 10–13 …”

Section: Introductionmentioning

confidence: 99%

“…Xu et al graded the quality of evidence used to justify the ESPEN and ASPEN guidelines and found that the majority (52%) were based on the clinical experience of those who created the recommendation. 9 Thus, the nutrition approach is often left to personal beliefs, the discretion of the attending personnel, or is determined by local logistical practices, despite data evidencing that a correct and adequate nutritional support may contribute to early recovery and better quality of life post-ICU stay. [10][11][12][13] This narrative review aims to gather the current literature on nutrition during ECLS and to provide a summary of potential recommendations considering the following relevant topics: caloric intake in the acute and chronic phases, specific energy expenditure-monitoring tailored for ECLS, type of macronutrients needed, route for nutrition, and considerations for COVID-19 patients supported by ECLS.…”

Section: Introductionmentioning

confidence: 99%

Nutrition during extracorporeal life support: A review of pathophysiological bases and application of guidelines

2022

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Background Patients on extracorporeal life support (ECLS), either for respiratory or cardiac support, are at high risk of malnutrition; guidelines on nutrition in critical care have not incorporated solid evidence regarding these settings. The aim of this narrative review is to gather the available evidence in the existing literature and transpose general principles to the ECLS population. Methods A literature review of observational and interventional studies on nutrition during ECLS, and evaluation of nutrition guidelines in this perspective. Results Nutrition is paramount for improving outcomes in ECLS, as well as in critically ill patients. The caloric needs during ECLS can vary according to the severity of the clinical state, sedation, paralysis, and temperature stability. Precise evaluation of energy expenditure by indirect calorimetry is difficult because ECLS is a system dedicated to removing carbon dioxide; however, modified equations composed of carbon dioxide values taken from the membrane lung are available. Guidelines suggest starting early enteral nutrition (EN) with a hypocaloric (70%–80% of the needs) strategy, also in acute states such as septic or cardiogenic shock. Moreover, EN, despite previous concerns, is feasible in prone position, an increasingly adopted strategy during mechanical ventilation. The catabolic state is maximal in these patients, causing a protein and muscular reduction. Therefore, adequate protein delivery should be guaranteed by administering a high protein intake of up to 2 g/kg/day. Conclusions Studies on nutrition tailored to ECLS patients are warranted. Early hypocaloric EN with high protein intake, tailored on indirect calorimetry, may be the most appropriate option.

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Evaluation of the quality of evidence supporting guideline recommendations for the nutritional management of critically ill adults

Cited by 5 publications

References 20 publications

Consensus recommendations on holistic care in hereditary ATTR amyloidosis: an international Delphi survey of patient advocates and multidisciplinary healthcare professionals

Consensus recommendations on holistic care in hereditary ATTR amyloidosis: an international Delphi survey of patient advocates and multidisciplinary healthcare professionals

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Nutrition during extracorporeal life support: A review of pathophysiological bases and application of guidelines

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