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Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient
- Source :
- Critical Care Medicine. 44:390-438
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- A.S.P.E.N. and SCCM are both nonprofit organizations composed of multidisciplinary healthcare professionals. The mission of A.S.P.E.N. is to improve patient care by advancing the science and practice of clinical nutrition and metabolism. The mission of SCCM is to secure the highest quality care for all critically ill and injured patients. Guideline Limitations: These A.S.P.E.N.−SCCM Clinical Guidelines are based on general conclusions of health professionals who, in developing such guidelines, have balanced potential benefits to be derived from a particular mode of medical therapy against certain risks inherent with such therapy. However, practice guidelines are not intended as absolute requirements. The use of these practice guidelines does not in any way project or guarantee any specific benefit in outcome or survival. The judgment of the healthcare professional based on individual circumstances of the patient must always take precedence over the recommendations in these guidelines. The guidelines offer basic recommendations that are supported by review and analysis of the current literature, other national and international guidelines, and a blend of expert opinion and clinical practicality. The population of critically ill patients in an intensive care unit (ICU) is not homogeneous. Many of the studies on which the guidelines are based are limited by sample size, patient heterogeneity, variability in disease severity, lack of baseline nutritional status, and insufficient statistical power for analysis. Periodic Guideline Review and Update: This particular report is an update and expansion of guidelines published by A.S.P.E.N. and SCCM in 2009 (1). Governing bodies of both A.S.P.E.N. and SCCM have mandated that these guidelines be updated every three to five years. The database of randomized controlled trials (RCTs) that served as the platform for the analysis of the literature was assembled in a joint “harmonization process” with the Canadian Clinical Guidelines group. Once completed, each group operated separately in their interpretation of the studies and derivation of guideline recommendations (2). The current A.S.P.E.N. and SCCM guidelines included in this paper were derived from data obtained via literature searches by the authors through December 31, 2013. Although the committee was aware of landmark studies published after this date, these data were not included in this manuscript. The process by which the literature was evaluated necessitated a common end date for the search review. Adding a last-minute landmark trial would have introduced bias unless a formalized literature search was re-conducted for all sections of the manuscript. Target Patient Population for Guideline: The target of these guidelines is intended to be the adult (≥ 18 years) critically ill patient expected to require a length of stay (LOS) greater than 2 or 3 days in a medical ICU (MICU) or surgical ICU (SICU). The current guidelines were expanded to include a number of additional subsets of patients who met the above criteria, but were not included in the previous 2009 guidelines. Specific patient populations addressed by these expanded and updated guidelines include organ failure (pulmonary, renal, and liver), acute pancreatitis, surgical subsets (trauma, traumatic brain injury [TBI], open abdomen [OA], and burns), sepsis, postoperative major surgery, chronic critically ill, and critically ill obese. These guidelines are directed toward generalized patient populations but, like any other management strategy in the ICU, nutrition therapy should be tailored to the individual patient. Target Audience: The intended use of these guidelines is for all healthcare providers involved in nutrition therapy of the critically ill, primarily physicians, nurses, dietitians, and pharmacists. Methodology: The authors compiled clinical questions reflecting key management issues in nutrition therapy. A committee of multidisciplinary experts in clinical nutrition composed of physicians, nurses, pharmacists, and dietitians was jointly convened by the two societies.
- Subjects :
- Lung Diseases
0301 basic medicine
Parenteral Nutrition
Time Factors
Medicine (miscellaneous)
Comorbidity
Critical Care and Intensive Care Medicine
law.invention
0302 clinical medicine
Randomized controlled trial
Risk Factors
law
Medicine
Renal Insufficiency
030212 general & internal medicine
Medical nutrition therapy
Randomized Controlled Trials as Topic
education.field_of_study
Nutrition and Dietetics
Respiratory Aspiration
Intensive care unit
Observational Studies as Topic
Intensive Care Units
Acute Disease
Practice Guidelines as Topic
Cohort study
medicine.medical_specialty
Critical Care
Critical Illness
Population
MEDLINE
Clinical nutrition
Risk Assessment
03 medical and health sciences
Enteral Nutrition
Sepsis
Intensive care
Dietary Carbohydrates
Humans
Obesity
education
Intensive care medicine
Monitoring, Physiologic
Postoperative Care
030109 nutrition & dietetics
Dose-Response Relationship, Drug
business.industry
Evidence-based medicine
Guideline
Dietary Fats
United States
Clinical trial
Parenteral nutrition
Nutrition Assessment
Pancreatitis
Chronic Disease
Dietary Supplements
Energy Intake
business
Liver Failure
Subjects
Details
- ISSN :
- 00903493
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- Critical Care Medicine
- Accession number :
- edsair.doi.dedup.....8ab8594e69c66e9594f22c5531b9fb2f
- Full Text :
- https://doi.org/10.1097/ccm.0000000000001525