The Influence of Polymeric Versus Oligomeric Enteral Feeding on Tolerance and Nutritional Status in Paediatric Intensive Care Pilot

NCT ID: NCT05271565

Last Updated: 2023-02-13

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-04-21

Study Completion Date

2023-08-31

Brief Summary

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Malnutrition is associated with negative impact on morbidity and mortality of critically ill patients. Therefore, in patients unable of peroral intake, the nutritional support is indicated. The preferred form of nutritional support is enteral, the more natural form, compared to parenteral. The enteral nutrition is cheaper and is associated with better outcomes and lower incidence of associated complications. The intolerance of enteral feeding is common in critically ill patients, and is associated with insufficient energy and protein intake, that could be linked with the complications such aspiration pneumonia. The optimization of enteral feeding tolerance is therefore one of the research priorities. Implementation of feeding protocols is associated with better tolerance. The enteral feeding could be administered as a oligomeric or polymeric formula. The are preliminary data from adult population pointing at better tolerance of oligomeric feeding formula.

Detailed Description

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After Ethics Committee approval, all paediatric patients admitted to the paediatric intensive care unit (PICU) will underwent PICU screening. In case of eligible for inclusion in to the study, the baseline parameters a demographics will be evaluated together with the initial laboratory sampling after approval and singed the informed consent by the legal guardian of the patient. Patients will be randomized by the online randomizer to the oligomeric and polymeric enteral nutrition group.

Polymeric (control group): Patients indicated for at least 2 days of enteral nutrition by the gastric tube. The nutritional support will be initiated after initial haemodynamic stabilization (blood levels of lactate normalization, norepinephrine infusion \<0,1 ug/kg/min) in the 48-hours interval from admission in form of bolus administration of polymeric formula. The initial dose will be 10% of the target volume (by Schofield equation). The gastric residual volume will be evaluated after 4 hours from bolus dose. In case of gastric residual volume lower than half of previously administered dose, the next dose will be elevated by 10% with the aim to reach the target dose in 48 hours. In case of higher residual volume, the same amount will be administered with the metoclopramid (3 times per day). In case of persistent residual volume higher than half of initial dose in 12 hours, the erythromycin will be initiated for 3 days. The bolus enteral feeding will be administered at the predefined time 5/day (6:00, 10:00, 14:00, 18:00, 22:00). The last gastric decompression is planned ad 24:00. The aim is to reach energetic goal defined by Schofield equation.

Interventional (oligomeric group): Patients indicated for at least 2 days of enteral nutrition by the gastric tube. The nutritional support will be initiated after initial haemodynamic stabilization (blood levels of lactate normalization, norepinephrine infusion \<0,1 ug/kg/min) in the 48-hours interval from admission in form of bolus administration of oligomeric formula. The initial dose will be 10% of the target volume (by Schofield equation). The gastric residual volume will be evaluated after 4 hours from bolus dose. In case of gastric residual volume lower than half of previously administered dose, the next dose will be elevated by 10% with the aim to reach the target dose in 48 hours. In case of higher residual volume, the same amount will be administered with the metoclopramid (3 times per day). In case of persistent residual volume higher than half of initial dose in 12 hours, the erythromycin will be initiated for 3 days. The bolus enteral feeding will be administered at the predefined time 5/day (6:00, 10:00, 14:00, 18:00, 22:00). The las gastric decompression is planned ad 24:00. The aim is to reach energetic goal defined by Schofield equation.

Conditions

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Enteral Feeding Intolerance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Monocentric randomized pilot controlled trial with 2 groups: interventional (oligomeric formula) and control (polymeric)
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
The patients and the legal guardians will be blinded

Study Groups

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Oligomeric enteral feeding group

Oligomeric enteral nutrition will be administered according to the study protocol

Group Type EXPERIMENTAL

Oligomeric enteral feeding

Intervention Type DIETARY_SUPPLEMENT

Oligomeric enteral formula

Polymeric enteral feeding group

Polymeric enteral nutrition will be administered according to the study protocol

Group Type ACTIVE_COMPARATOR

Polymeric enteral feeding

Intervention Type DIETARY_SUPPLEMENT

Polymeric enteral feeding will be administered to the PICU patients

Interventions

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Oligomeric enteral feeding

Oligomeric enteral formula

Intervention Type DIETARY_SUPPLEMENT

Polymeric enteral feeding

Polymeric enteral feeding will be administered to the PICU patients

Intervention Type DIETARY_SUPPLEMENT

Other Intervention Names

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Oligomeric enteral feeding will be administered to the PICU patients Polymeric enteral formula

Eligibility Criteria

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Inclusion Criteria

* PICU patients indicated for nutritional support by enteral feeding (gastric or jejunal)

Exclusion Criteria

* Enteral feeding contraindicated
* Persistent haemodynamic instability
* Informed consent not signed
* Acute pancreatitis
* Recent upper gastrointestinal surgery
* Gut perforation
* Ileus
Minimum Eligible Age

1 Month

Maximum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Masaryk University

OTHER

Sponsor Role collaborator

Brno University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Petr Štourač, MD

Clinical Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Petr Stourac, prof. MD., Ph.D., MBA

Role: STUDY_CHAIR

Department of paediatric anaesthesiology and intensive care medicine

Locations

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Brno University Hospital

Brno, South Moravian, Czechia

Site Status RECRUITING

Countries

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Czechia

Central Contacts

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Jozef Klučka, assoc.prof.MD., Ph.D.

Role: CONTACT

+420532234696

Milan Kratochvíl, MD. EDIC

Role: CONTACT

+420532234696

Facility Contacts

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Petr Štourač, assoc.prof.MD.Ph.D.

Role: primary

532234404 ext. 00420

Jozef Klučka, MD

Role: backup

532234696 ext. 00420

Other Identifiers

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KDAR FN Brno 2022/28/2

Identifier Type: -

Identifier Source: org_study_id

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