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.
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
Nutrients. 2022 Jun 23;14(13):2603. doi: 10.3390/nu14132603.
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. 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). 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. 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.
（1）使用 AGREE II 工具为危重症成人提供营养护理的临床实践指南（CPG），（2）使用 AGREE-REX 工具确定能量消耗的 CPG 建议。本研究纳入了专业学会或学术团体制定的、旨在指导危重症成人营养护理的 CPG，这些 CPG 使用了系统的文献检索并对证据进行了评估。从 2011 年 1 月至 2022 年 1 月 19 日，检索了四个数据库和灰色文献。五位研究者评估了 CPG 和特定于能量消耗确定的建议的方法学质量。为 AGREE II 计算了量表域得分，为 AGREE-REX 计算了量表总分。数据以中位数（四分位距）表示。纳入了 11 项 CPG。AGREE II 得分最高的领域是表述清晰度（82% [76%-87%]）和范围和目的（78% [66%-83%]）。得分最低的领域是适用性（37% [32%-42%]）和利益相关者参与度（46% [33%-51%]）。其中 8 项（73%）CPG 提供了与能量消耗确定相关的建议；总体评分较低（37% [36%-40%]），且各领域评分均较低。为危重症患者制定的营养 CPG 是使用系统方法制定的，但缺乏与关键利益相关者的接触，也缺乏支持应用的指南。能量消耗确定建议的质量较低。
