Dataset Information

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations.

ABSTRACT:

Background

Nutrition plays a vital role in the outcome of critically ill children, particularly those with AKI. Currently, there are no established guidelines for children with AKI treated with continuous RRT (CRRT). A thorough understanding of the metabolic changes and nutritional challenges in AKI and CRRT is required. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CRRT.

Methods

PubMed, MEDLINE, Cochrane, and Embase databases were searched for articles related to the topic. Expertise of the authors and a consensus of the workgroup were additional sources of data in the article. Available articles on nutrition therapy in pediatric patients receiving CRRT through January 2023.

Results

On the basis of the literature review, the current evidence base was examined by a panel of experts in pediatric nephrology and nutrition. The panel used the literature review as well as their expertise to formulate clinical practice points. The modified Delphi method was used to identify and refine clinical practice points.

Conclusions

Forty-four clinical practice points are provided on nutrition assessment, determining energy needs, and nutrient intake in children with AKI and on CRRT on the basis of the existing literature and expert opinions of a multidisciplinary panel.

SUBMITTER: Raina R

PROVIDER: S-EPMC10914214 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations.

Raina Rupesh R Suchan Andrew A Sethi Sidharth K SK Soundararajan Anvitha A Vitale Victoria S VS Keller Gerri L GL Brown Ann-Marie AM Davenport Andrew A Shih Weiwen V WV Nada Arwa A Irving Sharon Y SY Mannemuddhu Sai Sudha SS Crugnale Aylin S AS Myneni Archana A Berry Katarina G KG Zieg Jakub J Alhasan Khalid K Guzzo Isabella I Lussier Natalie H NH Yap Hui Kim HK Bunchman Timothy E TE

Kidney360 20231219 2

<h4>Background</h4>Nutrition plays a vital role in the outcome of critically ill children, particularly those with AKI. Currently, there are no established guidelines for children with AKI treated with continuous RRT (CRRT). A thorough understanding of the metabolic changes and nutritional challenges in AKI and CRRT is required. Our objective was to create clinical practice points for nutritional assessment and management in critically ill children with AKI receiving CRRT.<h4>Methods</h4>PubMed, ...[more]

PMID: 38112754

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Project description:ObjectivesBlood cultures are fundamental in evaluating for sepsis, but excessive cultures can lead to false-positive results and unnecessary antibiotics. Our objective was to create consensus recommendations focusing on when to safely avoid blood cultures in PICU patients.DesignA panel of 29 multidisciplinary experts engaged in a two-part modified Delphi process. Round 1 consisted of a literature summary and an electronic survey sent to invited participants. In the survey, participants rated a series of recommendations about when to avoid blood cultures on five-point Likert scale. Consensus was achieved for the recommendation(s) if 75% of respondents chose a score of 4 or 5, and these were included in the final recommendations. Any recommendations that did not meet these a priori criteria for consensus were discussed during the in-person expert panel review (Round 2). Round 2 was facilitated by an independent expert in consensus methodology. After a review of the survey results, comments from round 1, and group discussion, the panelists voted on these recommendations in real-time.SettingExperts' institutions; in-person discussion in Baltimore, MD.SubjectsExperts in pediatric critical care, infectious diseases, nephrology, oncology, and laboratory medicine.InterventionsNone.Measurements and main resultsOf the 27 original recommendations, 18 met criteria for achieving consensus in Round 1; some were modified for clarity or condensed from multiple into single recommendations during Round 2. The remaining nine recommendations were discussed and modified until consensus was achieved during Round 2, which had 26 real-time voting participants. The final document contains 19 recommendations.ConclusionsUsing a modified Delphi process, we created consensus recommendations on when to avoid blood cultures and prevent overuse in the PICU. These recommendations are a critical step in disseminating diagnostic stewardship on a wider scale in critically ill children.

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Project description:ContextCardiovascular dysfunction is associated with poor outcomes in critically ill children.ObjectiveWe aim to derive an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children.Data sourcesElectronic searches of PubMed and Embase were conducted from January 1992 to January 2020 using medical subject heading terms and text words to define concepts of cardiovascular dysfunction, pediatric critical illness, and outcomes of interest.Study selectionStudies were included if they evaluated critically ill children with cardiovascular dysfunction and assessment and/or scoring tools to screen for cardiovascular dysfunction and assessed mortality, functional status, organ-specific, or other patient-centered outcomes. Studies of adults, premature infants (≤36 weeks gestational age), animals, reviews and/or commentaries, case series (sample size ≤10), and non-English-language studies were excluded. Studies of children with cyanotic congenital heart disease or cardiovascular dysfunction after cardiopulmonary bypass were excluded.Data extractionData were abstracted from each eligible study into a standard data extraction form, along with risk-of-bias assessment by a task force member.ResultsCardiovascular dysfunction was defined by 9 elements, including 4 which indicate severe cardiovascular dysfunction. Cardiopulmonary arrest (>5 minutes) or mechanical circulatory support independently define severe cardiovascular dysfunction, whereas tachycardia, hypotension, vasoactive-inotropic score, lactate, troponin I, central venous oxygen saturation, and echocardiographic estimation of left ventricular ejection fraction were included in any combination. There was expert agreement (>80%) on the definition.LimitationsAll included studies were observational and many were retrospective.ConclusionsThe Pediatric Organ Dysfunction Information Update Mandate panel propose this evidence-informed definition of cardiovascular dysfunction.

Dataset Information

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations.

Background

Methods

Results

Conclusions

Publications

Nutrition in Critically Ill Children with AKI on Continuous RRT: Consensus Recommendations.

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