Evidence-Based Guidelines for Nutritional Support of the Critically Ill: Results of a Bi-National Guideline Development Conference

The purpose of this guidelines initiative was to develop or update and validate an evidence-

based feeding guideline for critically ill patients. A widely accepted methodology was adopted,

which requires the identification of previously developed and validated evidence-based guidelines.

The process then specifies a methodology for identifying and assimilating evidence that may be

used to change or update the previously validated guidelines.

An extensive literature search was conducted (closeout date April 2003). Four hundred and

sixty five full text papers were retrieved and reviewed. The only evidence-based guideline for

feeding critically ill patients that had been validated in an RCT was identified (Martin et al. 2004).

When evaluated in a cluster randomised trial including 499 patients from 14 hospitals, the adoption

of this guideline resulted in a 10% reduction in mortality (p= 0.058) and an average decrease in

hospital stay of 10 days (p=0.003). The process and evidence used to support and update this

guideline is presented in this document.

The final ratified guideline was evaluated in a 27 hospital cluster randomised trial conducted

in Australia and New Zealand.