Developing this guideline
The recommendations in this guideline were systematically developed and based on trial evidence when possible. However, the guideline development group met many difficulties including: the breadth of the remit; limited time and resources; and an evidence base that was difficult to interpret. There were three main reasons for this difficulty in interpretation.
Most of the evidence consisted of small trials, applying different interventions and outcome measures to variable populations in different settings. This not only made individual trials statistically underpowered, but also limited the possibilities for meta-analyses.
It was difficult to make recommendations for people in the community when most research was conducted in hospitals.
Most randomised trials of enteral tube feeding or parenteral nutrition support have excluded, on ethical grounds, patients who were either already malnourished or were likely to eat little or nothing for several days (since those allocated to control groups might have had feeding withheld for significant periods). The trials therefore examined 'elective' supplementary use of enteral tube feeding or parenteral nutrition support rather than their use for any of the usual clinical indications.