Mesejo A, Vaquerizo Alonso C, Acosta Escribano J, Ortiz Leyba C, Montejo González J C
Hospital Clínico Universitario, Valencia, España.
Med Intensiva. 2011 Nov;35 Suppl 1:1-6. doi: 10.1016/S0210-5691(11)70001-8.
The Recommendations for Specialized Nutritional Support in Critically-Ill patients were drafted by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) in 2005. Given the time elapsed since then, these recommendations have been reviewed and updated as a Consensus Document in collaboration with the Spanish Society of Parenteral and Enteral Nutrition (SENPE). The primary aim of these Recommendations was to evaluate the best available scientific evidence for the indications of specialized nutritional and metabolic support in critically-ill patients. The Recommendations have been formulated by an expert panel with broad experience in nutritional and metabolic support in critically-ill patients and were drafted between October 2009 and March 2011. The studies analyzed encompassed metaanalyses, randomized clinical trials, observational studies, systematic reviews and updates relating to critically-ill adults in MEDLINE from 1966 to 2010, EMBASE reviews from 1991 to 2010 and the Cochrane Database of Systematic Reviews up to 2010. The methodological criteria selected were those established in the Scottish Intercollegiate Guidelines Network and the Agency for Health Care policy and Research, as well as those of the Jadad Quality Scale. Adjustment for the level of evidence and grade of recommendation was performed following the proposal of the GRADE group (Grading of Recommendations Assessment, Development and Evaluation Working Group). Sixteen pathological scenarios were selected and each of them was developed by groups of three experts. A feedback system was established with the five members of the Editorial Committee and with the entire Working Group. All discrepancies were discussed and consensus was reached over several meetings, with special emphasis placed on reviewing the levels of evidence and grades of recommendation. The Editorial Committee made the final adjustments before the document was approved by all the members of the Working Group. Finally, the document was submitted to the Scientific Committees of the two Societies participating in the Consensus for final approval. The present Recommendations aim to serve as a guide for clinicians involved in the management and treatment of critically-ill patients and for any specialists interested in the nutritional treatment of hospitalized patients.
《危重症患者特殊营养支持建议》由西班牙重症监护医学与冠心病监护病房学会（SEMICYUC）代谢与营养工作组于2005年起草。鉴于自那时起已过去的时间，这些建议已与西班牙肠外与肠内营养学会（SENPE）合作进行了审查并更新为一份共识文件。这些建议的主要目的是评估危重症患者特殊营养和代谢支持指征的最佳现有科学证据。这些建议由在危重症患者营养和代谢支持方面具有广泛经验的专家小组制定，于2009年10月至2011年3月起草。所分析的研究包括1966年至2010年MEDLINE中关于危重症成人的荟萃分析、随机临床试验、观察性研究、系统评价及更新，1991年至2010年EMBASE综述以及截至2010年的Cochrane系统评价数据库。所选的方法学标准是苏格兰跨学院指南网络和医疗保健政策与研究机构制定的标准，以及雅达质量量表的标准。根据GRADE小组（推荐分级评估、制定与评价工作组）的提议对证据水平和推荐等级进行了调整。选择了16种病理情况，每种情况由三名专家组成的小组进行编写。与编辑委员会的五名成员和整个工作组建立了反馈系统。所有分歧都进行了讨论，并在几次会议上达成了共识，特别强调审查证据水平和推荐等级。在文件得到工作组所有成员批准之前，编辑委员会进行了最终调整。最后，该文件提交给参与共识的两个学会的科学委员会进行最终批准。本建议旨在为参与危重症患者管理和治疗的临床医生以及对住院患者营养治疗感兴趣的任何专家提供指导。
