Journal ArticleDOI
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
Nilesh M. Mehta,Heather E. Skillman,Sharon Y. Irving,Jorge A. Coss-Bu,Sarah Vermilyea,Elizabeth Anne Farrington,Liam McKeever,Amber M. Hall,Praveen S. Goday,Carol L. Braunschweig +9 more
Reads0
Chats0
TLDR
This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children.Abstract:
This document represents the first collaboration between two organizations, American Society of 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 (> 1 mo and < 18 yr) critically ill patient expected to require a length of stay greater than 2 or 3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2,032 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 1,661 citations. In total, the search for clinical trials yielded 1,107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer one of the eight preidentified question groups for this guideline. We used the Grading of Recommendations, Assessment, Development and Evaluation criteria 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 nutritional assessment, particularly the detection of malnourished patients who are most vulnerable and therefore potentially 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 is an area 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.read more
Citations
More filters
Dissertation
Nutritional status and its relationship with infection-related complications in children after cardiac surgery
TL;DR: Staphylococcus aureus carriage should be targeted prior to surgery and during subsequent hospitalisation, and more research undertaken on the role of postoperative feeding in improving outcomes following neonatal cardiac surgery.
Journal ArticleDOI
Feed intolerance and postpyloric feeding in the critically ill child
TL;DR: Evidence does not support the routine use of these methods to manage FI in critically ill children and future research must focus on clarifying the potential mechanisms of FI during critical illness as well as finding a proper and validate definition of FI.
Journal ArticleDOI
Use of an Electronic Feeds Calorie Calculator in the Pediatric Intensive Care Unit.
TL;DR: The use of a calorie-based protocol with an electronic calculator led to an improvement in the accuracy of the prescribed feeds and the time required to attain full enteral feeding.
Journal ArticleDOI
Undernutrition in critically ill children
Yara Maria Franco Moreno,Julia Carvalho Ventura,Luna Dias de Almeida Oliveira,Taís Thomsen Silveira,Daniela Barbieri Hauschild +4 more
TL;DR: This review identified that previous studies have used diverse nutritional indicators and cut-offs to recognize undernutrition in critically ill children, as well as anthropometric measurements and laboratory markers, to identify undernutrition at admission and during PICU stay.
Journal ArticleDOI
Strategies to optimize enteral feeding and nutrition in the critically ill child
TL;DR: The physiology of metabolic derangements that occur during critical illness are discussed, how to determine optimal nutrition prescription is outlined, and benefits of early enteral nutrition are discussed.
References
More filters
Journal ArticleDOI
Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe,Pieter Wouters,Frank Weekers,Charles Verwaest,Frans Bruyninckx,Miet Schetz,Dirk Vlasselaers,Patrick Ferdinande,Peter Lauwers,Roger Bouillon +9 more
TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
Journal ArticleDOI
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
Nilesh M. Mehta,Heather E. Skillman,Sharon Y. Irving,Jorge A. Coss-Bu,Sarah Vermilyea,Elizabeth Anne Farrington,Liam McKeever,Amber M. Hall,Praveen S. Goday,Carol L. Braunschweig +9 more
TL;DR: 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 and there is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake.
Journal ArticleDOI
Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient
Stephen A. McClave,Robert G. Martindale,Vincent W. Vanek,Mary McCarthy,Pamela R. Roberts,Beth Taylor,Juan B. Ochoa,Lena Napolitano,Gail A. Cresci +8 more
Journal ArticleDOI
Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data
Donald E. G. Griesdale,Russell J. de Souza,Rob M. van Dam,Daren K. Heyland,Deborah J. Cook,Atul Malhotra,Rupinder Dhaliwal,William R. Henderson,Dean R. Chittock,Simon Finfer,Daniel Talmor +10 more
TL;DR: Intensive insulin therapy significantly increased the risk of hypoglycemia and conferred no overall mortality benefit among critically ill patients, but this therapy may be beneficial to patients admitted to a surgical ICU.