☆ 4.6 Article

Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations

INTENSIVE CARE MEDICINE (2020)

Journal

INTENSIVE CARE MEDICINE

Volume 46, Issue 3, Pages 411-425

Publisher

SPRINGER

DOI: 10.1007/s00134-019-05922-5

Keywords

Enteral nutrition; Parenteral nutrition; Child; Paediatric; Intensive care; Guidelines

Funding

European Society of Pediatric and Neonatal Intensive Care (ESPNIC)

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Abstract

Background Nutritional support is considered essential for the outcome of paediatric critical illness. There is a lack of methodologically sound trials to provide evidence-based guidelines leading to diverse practices in PICUs worldwide. Acknowledging these limitations, we aimed to summarize the available literature and provide practical guidance for the paediatric critical care clinicians around important clinical questions many of which are not covered by previous guidelines. Objective To provide an ESPNIC position statement and make clinical recommendations for the assessment and nutritional support in critically ill infants and children. Design The metabolism, endocrine and nutrition (MEN) section of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) generated 15 clinical questions regarding different aspects of nutrition in critically ill children. After a systematic literature search, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was applied to assess the quality of the evidence, conducting meta-analyses where possible, to generate statements and clinical recommendations, which were then voted on electronically. Strong consensus (> 95% agreement) and consensus (> 75% agreement) on these statements and recommendations was measured through modified Delphi voting rounds. Results The final 15 clinical questions generated a total of 7261 abstracts, of which 142 publications were identified relevant to develop 32 recommendations. A strong consensus was reached in 21 (66%) and consensus was reached in 11 (34%) of the recommendations. Only 11 meta-analyses could be performed on 5 questions. Conclusions We present a position statement and clinical practice recommendations. The general level of evidence of the available literature was low. We have summarised this and provided a practical guidance for the paediatric critical care clinicians around important clinical questions.

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ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit

Pierre Singer, Annika Reintam Blaser, Mette M. Berger, Philip C. Calder, Michael Casaer, Michael Hiesmayr, Konstantin Mayer, Juan Carlos Montejo-Gonzalez, Claude Pichard, Jean -Charles Preiser, Wojciech Szczeklik, Arthur R. H. van Zanten, Stephan C. Bischoff

Summary: Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline on medical nutrition therapy for critically ill patients has been shortened and partially revised. This publication proposes a practical guideline based on the published scientific guideline, but with shortened and illustrated flow charts. The main goal of this practical guideline is to increase understanding and facilitate implementation of Nutrition in the ICU guidelines, including all items discussed in the previous guidelines and special conditions.

CLINICAL NUTRITION (2023)