A systematic review on the agreement between clinical practice guidelines regarding the steps of the nutrition care process of adult patients who are critically ill.

BACKGROUND

Clinical practice guidelines (CPGs) for the nutrition management of adult patients who are critically ill present divergences on recommendations regarding the nutrition care process (NCP), which bring difficulties in their application. We aimed to compare the recommendations from these CPGs and present a synthesis of them for each step of the NCP in intensive care unit (ICU) settings.

METHODS

Systematic review of CPGs on nutrition care in ICU, searched in six databases up to January 2022. We have extracted data about CPGs, steps of the NCP, and quality of evidence for each recommendation. We compiled the recommendations from each CPG for each step of the NCP and calculated the relative frequency of agreement between them.

RESULTS

Ten CPGs were reviewed, and 9 made recommendations for energy requirement, time to start, and route for nutrition support; however, only 3 presented recommendations on nutrition monitoring. The relative frequency of agreement between the recommendations of the CPGs ranges from 11% to 100%. The highest agreement was for the determination of energy requirements by indirect calorimetry and the provision of high protein for patients who are obese (100%). The lowest agreement among the CPGs was for considering either enteral nutrition or parenteral nutrition (PN) as an acceptable route (11%) and when to start PN (16.7%). Most recommendations were based on expert consensus.

CONCLUSIONS

There is a wide divergence on the recommendations to NCP of patients who are critically ill. This systematic review summarizes recommendations to evidence-based practice in ICU settings to facilitate the daily decisions of professionals.