Evaluation of Nutritional Practices in the Critical Care

NCT ID: NCT03634943

Last Updated: 2022-03-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

642 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-04-23

Study Completion Date

2022-03-22

Brief Summary

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Background: The adequacy of the artificial Nutritional Support (NS) in the critical care patient has implications in morbidity and prognosis. Clinical practice guidelines (CPG) are an important tool for healthcare professionals in their daily practice and a method of consultation for the correct treatment of patients. Also, the evidence remains low and there are important controversies regarding the NS in the critical care patient.

Hypothesis: The NS generates great controversy in the professionals involved in the care of critical care patients due to the contradictory results in literature. Despite this, the CPG should serve to standardize the treatment of patients and provide a better adherence to current knowledge in this setting. The importance of NS is underestimated and there is a need to perform proper evaluation of the impact of nutrition.

Objectives: To evaluate and analyze NS practices in critically ill patients in different ICUs and assess the adherence to CPGs. To evaluate the relationship of nutrition and outcomes in the ICU.

Methodology: Prospective multicenter observational study. Collection of variables from different participating ICUs and the characteristics of the NS of the different admitted patients. Monitoring of nutritional practices and complications. Evaluation of outcomes (e.g. mortality, ICU complications, etc.) with NS.

Expected results: Better understanding of the NS and its impact on morbidity and mortality; development of strategies to reduce low adherence to CPGs, improving the quality of care associated with this field in critical care patients; obtain clinical information that will serve as a basis for conducting intervention studies.

Detailed Description

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Methods (additional information): The NS (Nutritional Support) in the ICUs will be administered according to the usual practice of the medical and nursing staff and to the protocols established in each unit. The rate of initiation, the dose of macronutrients and the increase in contributions will be made according to the criteria of each participating ICU and the responsible physician (including the use of prokinetics or parenteral nutrition).

All the complications described associated with the artificial Nutritional support and others related to the critical patient will be evaluated daily by the research team and reflected in the electronic data collection form (eCRF).

The eCRF has been carried out through the REDCAP ™ platform and designed by the Department of Information Technology of Lleida of the Universitari Arnau de Vilanova Hospital, under the supervision of Dr. Lluís Servià, principal investigator of the present project. The responsible of the computer centre is Joan Escobar-Ortiz. The data will be stored in a server of the center and will be coded to comply with the confidentiality of the same and for a correct anonymization of patients based on Regulatory Laws.

The study has the approval of each ethics committee of each participating centre.

Statistical analyses will be performed by the department of statistics of University of Lleida under close supervision of Javier Trujillano-Cabello and the principal investigators of the present study.

Conditions

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Nutritional Support Intensive Care Unit Critical Illness

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients with Nutritional Support

Patients expected to be admitted \>72h at the Intensive Care Unit with the need of artificial Nutritional Support

Patients with Nutritional Support

Intervention Type OTHER

Evaluation of Enteral Nutrition or Parenteral Nutrition or both administered to the patients needing artificial Nutritional Support

Interventions

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Patients with Nutritional Support

Evaluation of Enteral Nutrition or Parenteral Nutrition or both administered to the patients needing artificial Nutritional Support

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age \>18 years old.
* Need of ICU admission \>72h.
* Need of Artificial Nutrional Support (Enteral Nutrition or Parenteral Nutrition or both).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Arnau de Vilanova

OTHER

Sponsor Role collaborator

Hospital Universitario 12 de Octubre

OTHER

Sponsor Role collaborator

Hospital Universitari de Bellvitge

OTHER

Sponsor Role lead

Responsible Party

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Juan Carlos Lopez-Delgado, PhD

Intensive Care Specialist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Teodoro Grau-Carmona, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Hospital 12 de Octubre

Lluís Servia-Goixart, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Hospital Arnau de Vilanova / Biomedical Research Institute of Lleida (IRBLleida) Institut de Recerca Biomèdica de Lleida

Juan Carlos Lopez-Delgado, Ph.D

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitari de Bellvitge

Locations

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Hospital Sant Joan d' Alacant

Sant Joan d'Alacant, Alicante, Spain

Site Status

H. Manacor

Manacor, Balearic Islands, Spain

Site Status

Hospital Universitari Germans Trias i Pujol

Badalona, Barcelona, Spain

Site Status

H. General de Granollers

Granollers, Barcelona, Spain

Site Status

Hospital Universitari de Bellvitge (Cardiology Unit)

L'Hospitalet de Llobregat, Barcelona, Spain

Site Status

Hospital Universitari de Bellvitge

L'Hospitalet de Llobregat, Barcelona, Spain

Site Status

Hospital de Mataró

Mataró, Barcelona, Spain

Site Status

Hospital Mutua Terrasa.

Terrassa, Barcelona, Spain

Site Status

Hospital General Universitario de Castellón

Castellon, Castellón, Spain

Site Status

Hospital Universitario de Puerto Real

Puerto Real, Cádiz, Spain

Site Status

Hospital de Barbastro

Barbastro, Huesca, Spain

Site Status

Hospital Príncipe de Asturias

Alcalá de Henares, Madrid, Spain

Site Status

Hospital Quirón Sur

Alcorcón, Madrid, Spain

Site Status

Hospital Universitario de Fuenlabrada

Fuenlabrada, Madrid, Spain

Site Status

Hospital Universitario de Getafe

Getafe, Madrid, Spain

Site Status

Hospital Universitario Severo Ochoa

Leganés, Madrid, Spain

Site Status

Hospital Infanta Cristina

Parla, Madrid, Spain

Site Status

Hospital Universitario Infanta Sofía

San Sebastián de los Reyes, Madrid, Spain

Site Status

Complejo Hospitalario de Navarra

Pamplona, Navarre, Spain

Site Status

Hospital Álvaro Cunqueiro

Vigo, Pontevedra, Spain

Site Status

Hospital Universitario de A Coruña

A Coruña, , Spain

Site Status

Hospital General Universitario de Alicante

Alicante, , Spain

Site Status

Hospital del Mar

Barcelona, , Spain

Site Status

Hospital Plató

Barcelona, , Spain

Site Status

Hospital de la Santa Creu i Sant Pau.

Barcelona, , Spain

Site Status

Hospital Universitario de Burgos

Burgos, , Spain

Site Status

Hospital Universitari Josep Trueta

Girona, , Spain

Site Status

Hospital General San Jorge

Huesca, , Spain

Site Status

Hospital Universitari Arnau de Vilanova

Lleida, , Spain

Site Status

Hospital Universitario 12 de Octubre

Madrid, , Spain

Site Status

Hospital Universitario 12 de Octubre (Trauma Unit)

Madrid, , Spain

Site Status

Hospital Regional Universitario Carlos Haya

Málaga, , Spain

Site Status

Hospital General Universitario Reina Sofia

Murcia, , Spain

Site Status

Hosptial General Universitario Morales Meseguer

Murcia, , Spain

Site Status

Hospital Clinico Universitario de Valencia

Valencia, , Spain

Site Status

Hospital Clínico Universitario de Valencia

Valencia, , Spain

Site Status

Hospital Universitari Doctor Peset

Valencia, , Spain

Site Status

Hospital Clínico Universitario de Valladolid

Valladolid, , Spain

Site Status

Hospital Rio Hortega

Valladolid, , Spain

Site Status

Hospital Virgen de la Concha

Zamora, , Spain

Site Status

Hospital Clínico Lozano Blesa

Zaragoza, , Spain

Site Status

Hospital Miguel Servet

Zaragoza, , Spain

Site Status

Hospital Royo Villanova

Zaragoza, , Spain

Site Status

Countries

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Spain

References

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Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2001 Dec;29(12):2264-70. doi: 10.1097/00003246-200112000-00005.

Reference Type RESULT
PMID: 11801821 (View on PubMed)

Heyland D, Cook DJ, Winder B, Brylowski L, Van deMark H, Guyatt G. Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med. 1995 Jun;23(6):1055-60. doi: 10.1097/00003246-199506000-00010.

Reference Type RESULT
PMID: 7774216 (View on PubMed)

Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003 Jun;22(3):235-9. doi: 10.1016/s0261-5614(02)00215-7.

Reference Type RESULT
PMID: 12765661 (View on PubMed)

Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr. 2006 Feb;25(1):37-44. doi: 10.1016/j.clnu.2005.10.010.

Reference Type RESULT
PMID: 16321459 (View on PubMed)

Deitch EA. Role of the gut lymphatic system in multiple organ failure. Curr Opin Crit Care. 2001 Apr;7(2):92-8. doi: 10.1097/00075198-200104000-00007.

Reference Type RESULT
PMID: 11373517 (View on PubMed)

Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, Bellingan G, Leonard R, Mythen MG, Rowan KM; CALORIES Trial Investigators. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014 Oct 30;371(18):1673-84. doi: 10.1056/NEJMoa1409860. Epub 2014 Oct 1.

Reference Type RESULT
PMID: 25271389 (View on PubMed)

Patel JJ, Codner P. Controversies in Critical Care Nutrition Support. Crit Care Clin. 2016 Apr;32(2):173-89. doi: 10.1016/j.ccc.2015.11.002. Epub 2016 Feb 4.

Reference Type RESULT
PMID: 27016160 (View on PubMed)

Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest. 2006 Apr;129(4):960-7. doi: 10.1378/chest.129.4.960.

Reference Type RESULT
PMID: 16608945 (View on PubMed)

Flordelis Lasierra JL, Perez-Vela JL, Montejo Gonzalez JC. Enteral nutrition in the hemodynamically unstable critically ill patient. Med Intensiva. 2015 Jan-Feb;39(1):40-8. doi: 10.1016/j.medin.2014.04.002. Epub 2014 Jun 4. English, Spanish.

Reference Type RESULT
PMID: 24907000 (View on PubMed)

Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, Mehta S, McIntyre L, Solaiman O, Sakkijha MH, Sadat M, Afesh L; PermiT Trial Group. Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. N Engl J Med. 2015 Jun 18;372(25):2398-408. doi: 10.1056/NEJMoa1502826. Epub 2015 May 20.

Reference Type RESULT
PMID: 25992505 (View on PubMed)

National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012 Feb 22;307(8):795-803. doi: 10.1001/jama.2012.137. Epub 2012 Feb 5.

Reference Type RESULT
PMID: 22307571 (View on PubMed)

Wischmeyer PE. Are we creating survivors...or victims in critical care? Delivering targeted nutrition to improve outcomes. Curr Opin Crit Care. 2016 Aug;22(4):279-84. doi: 10.1097/MCC.0000000000000332. No abstract available.

Reference Type RESULT
PMID: 27327244 (View on PubMed)

Wei X, Day AG, Ouellette-Kuntz H, Heyland DK. The Association Between Nutritional Adequacy and Long-Term Outcomes in Critically Ill Patients Requiring Prolonged Mechanical Ventilation: A Multicenter Cohort Study. Crit Care Med. 2015 Aug;43(8):1569-79. doi: 10.1097/CCM.0000000000001000.

Reference Type RESULT
PMID: 25855901 (View on PubMed)

Lopez-Delgado JC, Servia-Goixart L, Grau-Carmona T, Bordeje-Laguna L, Portugal-Rodriguez E, Lorencio-Cardenas C, Vera-Artazcoz P, Macaya-Redin L, Martinez-Carmona JF, Marin Corral J, Flordelis-Lasierra JL, Seron-Arbeloa C, Alcazar-Espin MLN, Navas-Moya E, Aldunate-Calvo S, Nieto Martino B, Martinez de Lagran I. Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy. Front Nutr. 2023 Aug 24;10:1250305. doi: 10.3389/fnut.2023.1250305. eCollection 2023.

Reference Type DERIVED
PMID: 37693244 (View on PubMed)

Servia-Goixart L, Lopez-Delgado JC, Grau-Carmona T, Trujillano-Cabello J, Bordeje-Laguna ML, Mor-Marco E, Portugal-Rodriguez E, Lorencio-Cardenas C, Montejo-Gonzalez JC, Vera-Artazcoz P, Macaya-Redin L, Martinez-Carmona JF, Iglesias-Rodriguez R, Monge-Donaire D, Flordelis-Lasierra JL, Llorente-Ruiz B, Menor-Fernandez EM, Martinez de Lagran I, Yebenes-Reyes JC; ENPIC Study Investigators. Evaluation of Nutritional Practices in the Critical Care patient (The ENPIC study): Does nutrition really affect ICU mortality? Clin Nutr ESPEN. 2022 Feb;47:325-332. doi: 10.1016/j.clnesp.2021.11.018. Epub 2021 Nov 16.

Reference Type DERIVED
PMID: 35063222 (View on PubMed)

Other Identifiers

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PR401/17

Identifier Type: -

Identifier Source: org_study_id

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