1. Clinical Nutrition in Critical Care Medicine – Guideline of the German Society for Nutritional Medicine (DGEM)
- Author
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Konstantin Mayer, Wolfgang H. Hartl, Gunnar Elke, Stephan C. Bischoff, Geraldine de Heer, Tobias Graf, Axel R. Heller, K. Georg Kreymann, Andreas Rümelin, Elke Muhl, Ulrich Kampa, Thomas W. Felbinger, Christian Stoppe, Michael Adolph, Arved Weimann, Stephan Steiner, and Bernd Niemann
- Subjects
Societies, Scientific ,0301 basic medicine ,Parenteral Nutrition ,medicine.medical_specialty ,Critical Care ,Critical Illness ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Clinical nutrition ,Enteral administration ,Nutrition Policy ,03 medical and health sciences ,0302 clinical medicine ,Meta-Analysis as Topic ,Germany ,Humans ,Medicine ,Medical nutrition therapy ,Intensive care medicine ,Aged ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Nutritional Support ,business.industry ,Organ dysfunction ,Guideline ,Respiration, Artificial ,Clinical trial ,Observational Studies as Topic ,Parenteral nutrition ,Observational study ,Nutrition Therapy ,medicine.symptom ,business - Abstract
Summary Purpose Enteral and parenteral nutrition of adult critically ill patients varies in terms of the route of nutrient delivery, the amount and composition of macro- and micronutrients, and the choice of specific, immune-modulating substrates. Variations of clinical nutrition may affect clinical outcomes. The present guideline provides clinicians with updated consensus-based recommendations for clinical nutrition in adult critically ill patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g., mechanical ventilation) to maintain organ function. Methods The former guidelines of the German Society for Nutritional Medicine (DGEM) were updated according to the current instructions of the Association of the Scientific Medical Societies in Germany (AWMF) valid for a S2k-guideline. According to the S2k-guideline classification, no systematic review of the available evidence was required to make recommendations, which, therefore, do not state evidence- or recommendation grades. Nevertheless, we considered and commented the evidence from randomized-controlled trials, meta-analyses and observational studies with adequate sample size and high methodological quality (until May 2018) as well as from currently valid guidelines of other societies. The liability of each recommendation was described linguistically. Each recommendation was finally validated and consented through a Delphi process. Results In the introduction the guideline describes a) the pathophysiological consequences of critical illness possibly affecting metabolism and nutrition of critically ill patients, b) potential definitions for different disease phases during the course of illness, and c) methodological shortcomings of clinical trials on nutrition. Then, we make 69 consented recommendations for essential, practice-relevant elements of clinical nutrition in critically ill patients. Among others, recommendations include the assessment of nutrition status, the indication for clinical nutrition, the timing and route of nutrient delivery, and the amount and composition of substrates (macro- and micronutrients); furthermore, we discuss distinctive aspects of nutrition therapy in obese critically ill patients and those treated with extracorporeal support devices. Conclusion The current guideline provides clinicians with up-to-date recommendations for enteral and parenteral nutrition of adult critically ill patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g., mechanical ventilation) to maintain organ function. The period of validity of the guideline is approximately fixed at five years (2018–2023).
- Published
- 2019