711387

711
ch-article2017
PENXX
ENXXX
XXX10.1177/0148607117711387Journal of Parenteral and Enteral NutritionMehta et al

PENXXX10.1177/0148607117711387Journal of Parenteral and Enteral NutritionMehta et al

ch-article2017

Clinical Guidelines

Guidelines for the Provision and Assessment of Nutrition

Support Therapy in the Pediatric Critically Ill Patient:
711387 Society of Critical Care Medicine and American Society
for Parenteral and Enteral Nutrition

ClinicalM.
Nilesh Guidelines
Mehta, MD1; Heather E. Skillman, MS, RD, CSP, CNSC2;
Sharon Y. Irving, PhD, CRNP, FCCM, FAAN3; Jorge A. Coss-Bu, MD4;
Sarah Vermilyea, MS, RD, CSP, LD, CNSC5; Elizabeth Anne Farrington, PharmD, FCCP, FCC
Liam McKeever, MS, RDN7; Amber M. Hall, MS8; Praveen S. Goday, MBBS, CNSC9;
and Carol Braunschweig, PhD, RD10

Guidelines for the 1 Provision and Assessment of 2Nutrition

3 4
Support Therapy in the Pediatric
Abstract
5
Critically Ill Patient:
This document represents the first collaboration between 2 organizations—the American Society for Paren
Society of Critical Care Medicine
and the Society of Critical Care7 Medicine—to describe best
and
8 American Society 9
practices in nutrition therapy in critically ill c
for
NileshParenteral
M. Mehta, MD and; Enteral
Heather E. Nutrition
Skillman,
10 MS, RD, CSP, CNSC ;
guidelines is intended to be the pediatric critically ill patient (>1 month and <18 years) expected to require a
aSharon Y. Irving,
PICU admitting PhD, surgical,
medical, CRNP, and FCCM,cardiacFAAN ; Jorge
patients. A. 2032
In total, Coss-Bu, MDwere
citations ; scanned for relevanc
Sarah Vermilyea,
search resulted MS,
in 960 RD, CSP,
citations LD, CNSC
for clinical trials ;and
Elizabeth Anne for
925 citations Farrington, PharmD,
cohort studies. FCCP, FCC
The EMBASE sear
Liam McKeever, MS, RDN ; Amber M. Hall, MS ; Praveen S. Goday, MBBS, CNSC ;
1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielde
16
andrandomized controlled trialsPhD,
Carol Braunschweig, and 37RDcohort studies appeared to answer 1 of the 8 preidentified questio
We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) t
based on assessment of the quality of study design and execution. These guidelines are not intended for neo
guidelines reiterate the importance of nutrition assessment—particularly, the detection of malnourished patie
and
Thistherefore
document may benefit from
represents timely
the first intervention.between
collaboration There is2a organizations—the
need for renewed focus on accurate
American estimation
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Abstract
to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating
and the Society of Critical Care Medicine—to describe best practices in nutrition therapy in critically ill c equations an
unintended
guidelines iscaloric underfeeding
intended and overfeeding
to be the pediatric criticallyare
ill recommended.
patient (>1 month Optimal
and <18protein intake
years) and itstocorrelatio
expected require a
areas of great interest. The optimal route and timing of nutrient delivery are areas of intense
a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevanc debate and inve
remains the preferred
search resulted in 960route for nutrient
citations delivery.
for clinical trialsSeveral
and 925 strategies to for
citations optimize
cohortenteral nutrition
studies. during critica
The EMBASE sear
role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears
1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielde to be benefici
be
16 currently
randomized recommended. Overall,
controlled trials the cohort
and 37 pediatric critical
studies care population
appeared to answeris1heterogeneous, and a nuanced
of the 8 preidentified questio
nutrition support with the aim of improving clinical outcomes is necessary. (
(JPEN
JPEN
We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) J Parenter Enteral Nutr. t
based on assessment of the quality of study design and execution. These guidelines are not intended for neo
guidelines reiterate the importance of nutrition assessment—particularly, the detection of malnourished patie
Keywords
and therefore
adolescent; may benefit
algorithm; from
child; timelyillness;
critical intervention.
energy;There is nutrition;
enteral a need for guidelines;
renewed focus on accurate estimation
immunonutrition; indirect co
to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations
care unit; malnutrition; nutrition team; obesity; parenteral nutrition; pediatric; pediatric nutrition assessmen an
unintended caloric
resting energy underfeeding and overfeeding are recommended. Optimal protein intake and its correlatio
expenditure
areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and inve
remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critica
This
role ofdocument represents
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has been highlighted, 2 a delayed
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be American
currently recommended. Society
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Enteral Nutr.
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Medicine (SCCM)—to describe best practices in nutrition this document. These practice guide
therapy for critically ill children. absolute policy statements. Use of
does not in any way guarantee any
come or survival. The professional j
Guideline Limitations health professionals is the primar
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document. These practice guide
therapy for critically ill children. absolute policy statements. Use of
does not in any way guarantee any
come or survival. The professional j
health professionals is the primar
These SCCM-ASPEN clinical guidelines are based on general medical care delivery. Since guide
Guideline
consensus amongLimitations
a group of professionals who, in developing every variation in circumstances, p
such guidelines, have examined the available literature on exercise professional judgment whe
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multidisciplinary experts in clinical nutrition—representing ing and judgment.