ADVANCING GUIDELINES

Interview at ESPEN 2018 with Professor Michael Casaer from Leuven University by Meg Marquardt, Nestlé Health Science. Professor Casaer MD, PhD.

From ESPEN 2018, Madrid September 1-4 September.

MB: I have one of the committee members here with me, Professor Michael Casaer, who works at University Hospital Leuven, in the ICU, where he specialises also, not only in intensive care but in burns. So I’d like to ask you, Professor, what were the biggest challenges in forming the guidelines?

MC: Well, the good news was that we had, since the previous guidelines, where I was not yet a co-author, we had lots of new data generated in randomised controlled trials allowing us to refine and to adapt our recommendations. Of course, the challenge was to integrate all these things and try to make it into a message that makes sense rather than polarise and look at all the differences between the trials that are, of course, there. And I think and I hope that we were successful in trying to make this into a meaningful story and to create a bit of a paradigm shift where we moved away from the very early avoiding of caloric gap and rather went into a somewhat more prudent approach, going a bit slower towards building up a progressive, meaning step by step and not rushing into feeding comes back several times. So I think that’s for sure one of the challenges and one of the strong points of these new guidelines which also resulted in some level-A strong recommendations.

Most of these strong recommendations are on things not to do because we know now that they’re not as safe or as good as we thought. So I really think we have been able to integrate the new data into these guidelines. But as Pierre Singer, who did a great job in this, pointed out, in the end, of course, it’s not over and some recommendations will change over time or will become stronger when stronger data is available because not only the number of trials but also the quality of the trials has been judged in a very strict manner, and also the input of [unclear 02:17]MEG  was a very important [unclear] MEG say do we have the evidence to make a strong recommendation, yes or no? I think we stick to it in rather [a current manner 02:25] MEG.

MB: It looked as though you made your job easier by starting only from 2000 with the literature content, so you didn’t have to go back too far historically and justify stages?

MC: Yeah, well, that’s…that has been a difficult choice because, of course, many wonderful studies have been done by real pioneers in feeding before the year 2000. But, again, as Pierre Singer pointed out, it’s not so much how these studies were done but just the context of the ICU changed a lot. The ICU before the year 2000 is really another ICU with many ventilation-related complications, things you never see nowadays. Also we effective nutrition we had available was also different. So extrapolating or integrating these data into nowadays meta analysis may be misleading. And, on the other hand, the results have affected some of the standards introduced to increase the quality of the estimated effect size of interventions only occurred after the year 2000, such as registration of the endpoints before you start a study in [unclear 03:41], the [consort] recommendations on how to report data, many things that make it easier nowadays to have a clear view on the bias or absence of bias in randomised controlled trials than was the case in the old studies.

MB: One interesting topic seemed… because you’re working in the Netherlands, you have a lot of resources, and one thing that was clear was the importance and the increasing importance of indirect calorimetry but it doesn’t seem to be adopted everywhere by everyone for due to issues such simply as resources?

MC: Yeah, that’s a very good point. Just I don’t work in the Netherlands but in Belgium but never mind.

MB: I beg your pardon. I knew that.