title: Nutrition in critically ill adults: A systematic quality assessment of clinical practice guidelines.
abstract: Nutritional support in the acutely ill is a complex topic. Clinical practice guidelines (CPGs) have been developed to assist healthcare professionals working in this field. However, the quality of these clinical guidelines has not yet been systematically assessed. The objective of our study was to identify and assess the quality of CPGs on nutrition in critically ill adult patients.
  
  
  
  We performed a systematic search to identify CPGs on nutrition in critically ill adult patients. Three independent appraisers assessed six domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability and editorial independence) of the eligible CPGs using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) instrument.
  
  
  
  Nine CPGs were selected. Overall agreement among appraisers was very good (ICC: 0.853; 95% CI: 0.820-0.881). The mean scores for each AGREE domain were the following: "scope and purpose" 76.2% ± 13.7%; "stakeholder involvement" 42.8% ± 16.5%; "rigour of development" 57.9% ± 18.1%; "clarity of presentation" 76.9% ± 13.7%; "applicability" 30.1% ± 22.8%; and 42.1% ± 23.9% for "editorial independence". Four CPGs were deemed "Recommended"; three "Recommended with modifications"; and two "Not recommended". We did not observe improvement over time in the overall quality of the CPGs.
  
  
  
  The overall quality of CPGs on nutrition in critically ill adults is suboptimal, with only four CPGs being recommended for clinical use. Our results highlight the need to revise and improve CPG development processes in this field.
authors.affiliation: Iberoamerican Cochrane Centre, Barcelona, Spain; Faculty of Medicine and Dentistry, Universidad de Antofagasta, Antofagasta, Chile; Hospital Regional de Antofagasta, Antofagasta, Chile. Electronic address: pfuentes@cochrane.es.
authors.forename: Paulina
authors.initials: P
authors.lastname: Fuentes Padilla
authors.affiliation: Iberoamerican Cochrane Centre, Barcelona, Spain; Faculty of Medicine and Dentistry, Universidad de Antofagasta, Antofagasta, Chile; Hospital Regional de Antofagasta, Antofagasta, Chile. Electronic address: gmartinez@cochrane.es.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Martínez
authors.affiliation: Iberoamerican Cochrane Centre, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. Electronic address: rwmvernooij@cochrane.es.
authors.forename: Robin W M
authors.initials: RWM
authors.lastname: Vernooij
authors.affiliation: Iberoamerican Cochrane Centre, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública, (CIBERESP), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: xbonfill@santpau.cat.
authors.forename: Xavier Bonfill
authors.initials: XB
authors.lastname: Cosp
authors.affiliation: Iberoamerican Cochrane Centre, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública, (CIBERESP), Barcelona, Spain; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. Electronic address: palonso@santpau.cat.
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D044623:Nutrition Therapy / Q000379:methods*; D009752:Nutritional Status; D017410:Practice Guidelines as Topic / Q000592:standards; D011785:Quality Assurance, Health Care
keywords: AGREE instrument; Clinical practice guidelines; Critically ill; Guidelines; Nutrition therapy; Quality assessment