Optimal nutrition therapy in paediatric critical care in the Asia-Pacific and Middle East: a consensus
- PMID: 27702711
- DOI: 10.6133/apjcn.012016.07
Optimal nutrition therapy in paediatric critical care in the Asia-Pacific and Middle East: a consensus
Abstract
Background and objectives: Current practices and available resources for nutrition therapy in paediatric intensive care units (PICUs) in the Asia Pacific-Middle East region are expected to differ from western countries. Existing guidelines for nutrition management in critically ill children may not be directly applicable in this region. This paper outlines consensus statements developed by the Asia Pacific-Middle East Consensus Working Group on Nutrition Therapy in the Paediatric Critical Care Environment. Challenges and recommendations unique to the region are described.
Methods and study design: Following a systematic literature search from 2004-2014, consensus statements were developed for key areas of nutrient delivery in the PICU. This review focused on evidence applicable to the Asia Pacific-Middle East region. Quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach.
Results: Enteral nutrition (EN) is the preferred mode of nutritional support. Feeding algorithms that optimize EN should be encouraged and must include: assessment and monitoring of nutritional status, selection of feeding route, time to initiate and advance EN, management strategies for EN intolerance and indications for using parenteral nutrition (PN). Despite heterogeneity in nutritional status of patients, availability of resources and diversity of cultures, PICUs in the region should consider involvement of dieticians and/or nutritional support teams.
Conclusions: Robust evidence for several aspects of optimal nutrition therapy in PICUs is lacking. Nutritional assessment must be implemented to document prevalence and impact of malnutrition. Nutritional support must be given greater priority in PICUs, with particular emphasis in optimizing EN delivery.
背景与目的：亚太中东地区儿科重症监护病房（PICU）营养治疗的现状和可用 资源与西方国家不同。现有的对危重症儿童营养管理的指南可能不能直接用于这 一地区。本文概述了亚太中东共识工作组制定的儿科重症监护环境下营养治疗的 共识声明，描述了这一地区独特的挑战和建议。方法与研究设计：系统检索了 2004-2014 年间的文献，形成了PICU 营养应用关键领域的共识声明。本综述重 点关注适用于亚太中东地区的证据。推荐的证据和强度的质量是根据推荐评估、 制定和评价方法的分级评分的。结果：肠内营养（EN）是首选的营养支持模 式、应鼓励最优化EN，其必须包括：评估和检测营养状态、给食途径的选择、 开始和增加EN 的时间、EN 不耐受的管理策略和使用肠外营养的适应症。因为 存在患者营养状态的异质性、资源的可用性和文化的多样性，这个地区的PICU 应该考虑营养师和/或营养团队的参与。结论：PICU 最佳营养治疗几个方面强有 力的证据是不足的。营养评估必须落实到患病率的记录和营养不良的影响。 PICU 必须优先考虑营养支持，尤其强调最优化EN 的应用。.