Xiao Deying, Xie Long, Lin Wenhong, Fu Jinhua, Deng Lin, Zhuang Qian, Liu Maobai
Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China.
The School of Pharmacy, Fujian Medical University, Fuzhou, 350004, People's Republic of China.
Int J Gen Med. 2024 Sep 7;17:3933-3944. doi: 10.2147/IJGM.S469991. eCollection 2024.
This evaluation aims to provide a reference for clinical decision-making regarding the use of SPN in intensive care unit (ICU) patients. The objective of this study is to evaluate the quality of clinical practice guidelines for the use of supplementary parenteral nutrition (SPN) in ICU patients, both domestically and internationally.
The quality of clinical practice recommendations for SPN use in ICU patients was assessed using a systematic approach.
Five nutrition recommendations in total were included for analysis. The average standardized scores for the recommendations across the six domains of the Appraisal of Guidelines for Research and Evaluation II (AGREE II) are as follows: Scope and purpose scored 87.96%, stakeholder Involvement scored 68.52%, rigour of development scored 73.40%, clarity of presentation scored 84.80%, applicability scored 64.72%, and editorial independence scored 91.10%. In the comprehensive evaluation, two guidelines were rated as grade A recommendations, and three were rated as grade B recommendations. Most guidelines recommended against early use of SPN when energy and protein requirements could not be met solely through enteral nutrition (EN) in ICU patients. The guidelines emphasized achieving target energy levels and discontinuing parenteral nutrition (PN) as soon as the energy requirements were met to prevent overfeeding.
This study utilized the AGREE II scale to assess the quality of five nutrition guidelines. All 5 guidelines were deemed acceptable Recommendations include focusing on participants, rigour, and applicability to enhance guideline quality. Clinicians should exercise professional judgment when applying guidelines as they complement training and judgment, rather than replacing them.
本评估旨在为重症监护病房（ICU）患者使用补充性肠外营养（SPN）的临床决策提供参考。本研究的目的是评估国内外ICU患者使用补充性肠外营养（SPN）的临床实践指南的质量。
采用系统方法评估ICU患者使用SPN的临床实践建议的质量。
共纳入五项营养建议进行分析。《研究与评价指南II》（AGREE II）六个领域的建议平均标准化得分如下：范围和目的得分87.96%，利益相关者参与度得分68.52%，制定的严谨性得分73.40%，表述清晰度得分84.80%，适用性得分64.72%，编辑独立性得分91.10%。综合评价中，两项指南被评为A级推荐，三项被评为B级推荐。大多数指南建议，当ICU患者仅通过肠内营养（EN）无法满足能量和蛋白质需求时，不建议早期使用SPN。指南强调实现目标能量水平，并在满足能量需求后尽快停止肠外营养（PN），以防止过度喂养。
本研究利用AGREE II量表评估了五项营养指南的质量。所有5项指南均被认为可接受。建议包括关注参与度、严谨性和适用性，以提高指南质量。临床医生在应用指南时应运用专业判断力，因为指南是对培训和判断力的补充，而非替代。
