|
1
|
Noyahr JK, Tatucu-Babet OA, Chapple LAS, Barlow CJ, Chapman MJ, Deane AM, Fetterplace K, Hodgson CL, Winderlich J, Udy AA, Marshall AP, Ridley EJ. Methodological Rigor and Transparency in Clinical Practice Guidelines for Nutrition Care in Critically Ill Adults: A Systematic Review Using the AGREE II and AGREE-REX Tools. Nutrients 2022; 14:2603. [PMID: 35807784 PMCID: PMC9268338 DOI: 10.3390/nu14132603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background: To evaluate the methodological quality of (1) clinical practice guidelines (CPGs) that inform nutrition care in critically ill adults using the AGREE II tool and (2) CPG recommendations for determining energy expenditure using the AGREE-REX tool. Methods: CPGs by a professional society or academic group, intended to guide nutrition care in critically ill adults, that used a systematic literature search and rated the evidence were included. Four databases and grey literature were searched from January 2011 to 19 January 2022. Five investigators assessed the methodological quality of CPGs and recommendations specific to energy expenditure determination. Scaled domain scores were calculated for AGREE II and a scaled total score for AGREE-REX. Data are presented as medians (interquartile range). Results: Eleven CPGs were included. Highest scoring domains for AGREE II were clarity of presentation (82% [76-87%]) and scope and purpose (78% [66-83%]). Lowest scoring domains were applicability (37% [32-42%]) and stakeholder involvement (46% [33-51%]). Eight (73%) CPGs provided recommendations relating to energy expenditure determination; scores were low overall (37% [36-40%]) and across individual domains. Conclusions: Nutrition CPGs for critically ill patients are developed using systematic methods but lack engagement with key stakeholders and guidance to support application. The quality of energy expenditure determination recommendations is low.
Collapse
Affiliation(s)
- John K. Noyahr
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
| | - Oana A. Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
| | - Lee-anne S. Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia;
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia;
| | - Christopher Jake Barlow
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland 1023, New Zealand;
| | - Marianne J. Chapman
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia;
| | - Adam M. Deane
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3010, Australia; (A.M.D.); (K.F.)
| | - Kate Fetterplace
- Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3010, Australia; (A.M.D.); (K.F.)
- Department of Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Jacinta Winderlich
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Paediatric Intensive Care Unit, Monash Children’s Hospital, Melbourne, VIC 3168, Australia
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Andrea P. Marshall
- Intensive Care Unit, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia;
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD 4222, Australia
| | - Emma J. Ridley
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (J.K.N.); (O.A.T.-B.); (C.L.H.); (J.W.); (A.A.U.)
- Nutrition Department, The Alfred Hospital, Melbourne, VIC 3004, Australia
| |
Collapse
|
|
3
|
Hsu CC, Sun CY, Tsai CY, Chen MY, Wang SY, Hsu JT, Yeh CN, Yeh TS. Metabolism of Proteins and Amino Acids in Critical Illness: From Physiological Alterations to Relevant Clinical Practice. J Multidiscip Healthc 2021; 14:1107-1117. [PMID: 34017176 PMCID: PMC8131070 DOI: 10.2147/jmdh.s306350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 12/29/2022] Open
Abstract
The clinical impact of nutrition therapy in critically ill patients has been known for years, and relevant guidelines regarding nutrition therapy have emphasized the importance of proteins. During critical illness, such as sepsis or the state following major surgery, major trauma, or major burn injury, patients suffer from a high degree of stress/inflammation, and during this time, metabolism deviates from homeostasis. The increased degradation of endogenous proteins in response to stress hormones is among the most important events in the acute phase of critical illness. Currently published evidence suggests that adequate protein supplementation might improve the clinical outcomes of critically ill patients. The role of sufficient protein supplementation may even surpass that of caloric supplementation. In this review, we focus on relevant physiological alterations in critical illness, the effects of critical illness on protein metabolism, nutrition therapy in clinical practice, and the function of specific amino acids.
Collapse
Affiliation(s)
- Chih-Chieh Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Ci-Yuan Sun
- Division of Colon & Rectal Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Ming-Yang Chen
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,Chang Gung University, Taoyuan, 333, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,Chang Gung University, Taoyuan, 333, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,Chang Gung University, Taoyuan, 333, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,Chang Gung University, Taoyuan, 333, Taiwan
| |
Collapse
|
|
4
|
Patel JJ, Martindale RG, Heyland DK. Unraveling Methodology to Ensure the Search for Optimal Nutrition Quantity in Acute Respiratory Distress Syndrome Remains INTACT. JPEN J Parenter Enteral Nutr 2018; 43:8-9. [PMID: 30251261 DOI: 10.1002/jpen.1443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/11/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Jayshil J Patel
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Robert G Martindale
- Division of General Surgery, Department of Surgery, Oregon Health Science University, Portland, Oregon, USA
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Public Health Sciences, Queen's University, Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| |
Collapse
|
|
5
|
Kozeniecki M, Pitts H, Patel JJ. Barriers and Solutions to Delivery of Intensive Care Unit Nutrition Therapy. Nutr Clin Pract 2018; 33:8-15. [PMID: 29323759 DOI: 10.1002/ncp.10051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/10/2017] [Accepted: 11/21/2017] [Indexed: 01/01/2023] Open
Abstract
Despite recommendations for early enteral nutrition (EN) in critically ill patients, numerous factors contribute to incomplete delivery of EN, including insufficient nutrition risk screening in critically ill patients, underutilization of enteral feeding protocols, fixed rate-based enteral infusion targets with frequent EN interruption, and suboptimal provider practices regarding nutrition support therapy. The purpose of this narrative review is to identify common barriers to optimizing and delivering nutrition in critically ill patients, and suggest strategies and solutions to overcome barriers.
Collapse
Affiliation(s)
- Michelle Kozeniecki
- Department of Nutrition Services, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Heather Pitts
- Department of Nutrition Services, Cone Health, Greensboro, North Carolina, USA
| | - Jayshil J Patel
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|