WHAT DO WE KNOW WHAT HAS CHANGED ABOUT NUTRITION
Abstract
Background
Critical illness results in disturbances to metabolic and endocrine function characterised by insulin resistance, catabolism and altered substrate utilisation. These changes are dynamic and evolve during the course of illness; namely the acute phase (with escalating organ support), stable phase (improving or stable clinical condition) and recovery phase (usually discharged from PICU where catch up growth/ rehabilitation may be required).
Objectives
The purpose of this talk is to review the main findings of the systematic review and what we currently know with regards to nutrition support in critically ill children.
Methods
The working group was composed of a multidisciplinary team of 11 European specialists (paediatric intensivists, nurses and dietitians) in nutritional support for critically ill children, who are members of the MEN section of the ESPNIC.
Results
A total of 7261 abstracts were screened. 143 publications were reviewed and data extracted and included in the development of the 33 recommendations. The general level of evidence was low. A strong consensus was reached in 85% of the recommendations with consensus in 15% of the recommendations. Nutrition support in each phase is likely to have distinct requirements/ challenges and nutrition support should be adapted to accommodate these changes, with respect to methods of nutritional assessment, micronutrient and macronutrient requirements, assessment of feeding tolerance, routes/ modes of feeding and types of nutrition support.
Conclusion
Consensus based nutrition recommendations based on best available evidence aims to promote optimal nutritional practices in critically ill children, reduce variation in practice, improve clinical outcomes and guide future research.
WHAT DON'T WE KNOW AND WHAT SHOULD BE STUDIED
Abstract
Background
Almost no high quality randomized trials with relevant clinical outcomes in the field of nutrition in the PICU currently exist. An increasing amount of, mainly adult, critical care nutrition trials have shown us that nutritional interventions have clinical relevant impact on short- and long-term outcome. Interestingly, these findings from methodologically sound randomized controlled trials (RCTs) could often not confirm and even refuted observational, or intermediate outcome studies. This challenges us to define areas of research which have the highest priority. Timing, route and requirements still form the priorities for clinical research in pediatric critical care nutrition. A concept which is becoming more accepted is that these modalities are dynamic and change during time with the different phases of illness; acute, stable and recovering. Identifying clinical or metabol(om)ic biomarkers, to distinguish these different phases would pave the way forward towards major progress in optimizing nutritional therapy. The optimal dose of macronutrients during the course of illness remains one of the most challenging questions. In addition to caloric intake, the optimal timing and dose of proteins require an alternate perspective and more investigation on low, or even no protein intake during acute critical illness should be considered. Research in optimal nutritional strategy should also include the route of feeding. Based on observational studies ‘early’ enteral nutrition is feasible and should be pursued, although how this should be done remains an area of great uncertainty.
Objectives
Objectives
Methods
Methods Methods
Results
Results Results
Conclusion
Conclusion