Optimizing Early Nutrition Support in Severe Stroke-2

NCT ID: NCT05998902

Last Updated: 2025-05-28

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

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

546 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-20

Study Completion Date

2026-10-31

Brief Summary

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Post stroke pneumonia (PSP) is one of the common early complications of stroke. Post-stroke infections, in general, are associated with less favorable neurologic outcomes. Aspiration is one of the most feared complications of enteral nutrition and can lead to the occurrence of pneumonia. Severe stroke patients are at high risk for aspiration due to some factors such as the reduced level of consciousness, inability to protect the airway and so on. The purpose of this study is to explore the ideal nutrition support strategy for patient with acute severe stroke to help reduce the incidence of PSP and improve the prognosis.

Detailed Description

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As one of the most common complication of stroke, some studies showed that post-stroke pneumonia (PSP) in stroke patients requiring intensive care is associated with an increase of ICU length of stay and hospital mortality and poorer functional outcomes in survivors. The peak period of PSP is within the first week after stroke. Aspiration and poor nutritional status are important factors leading to pneumonia in stroke patients. Compared with full enteral nutrition (EN), initial trophic enteral feeding was associated with less gastrointestinal intolerance and could reduce the rate of regurgitation. However, trophic enteral feeding could not meet the daily caloric needs and hypocaloric enteral nutrition might be associated with increased mortality. This study is designed to explore whether initial trophic enteral nutrition combined with supplemental parenteral nutrition (SPN) can help reduce the incidence of PSP and improve the prognosis in severe patients with stroke.

This study will enroll 546 severe stroke patients who meet the inclusion criteria. Upon admission to the ICU, patients will be randomly assigned at a 1:1 ratio into groups of full enteral feeding (controlled) and trophic enteral feeding combined with supplemental parenteral feeding (experimented) for 7 days.

Conditions

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Severe Stroke Acute Stroke Dysphagia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Full enteral feeding

Patients will receive full enteral feeding through nasogastric tube or nasointestinal tube.

Group Type ACTIVE_COMPARATOR

Full enteral feeding

Intervention Type PROCEDURE

The caloric goal of the first day is one-third of caloric requirements, the second day is half of caloric requirements, the third day is 70-100% and sustained for 1 week. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day. Enteral nutrition is given through nasogastric tube or nasointestinal tube.

Trophic enteral feeding combined with supplemental parenteral nutrition

Patients will receive trophic enteral feeding combined with supplemental parenteral feeding.

Group Type EXPERIMENTAL

Trophic enteral feeding combined with supplemental parenteral nutrition

Intervention Type PROCEDURE

The caloric goal of the first day is one-third of caloric requirements, the second day is half of caloric requirements, the third day is 70-100% and sustained for 1 week. Patients will receive the trophic enteral feeding with a caloric target of 500kcal/d (20-35ml/h), and the remaining calories are supplemented by parenteral nutrition. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day.

Interventions

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Trophic enteral feeding combined with supplemental parenteral nutrition

The caloric goal of the first day is one-third of caloric requirements, the second day is half of caloric requirements, the third day is 70-100% and sustained for 1 week. Patients will receive the trophic enteral feeding with a caloric target of 500kcal/d (20-35ml/h), and the remaining calories are supplemented by parenteral nutrition. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day.

Intervention Type PROCEDURE

Full enteral feeding

The caloric goal of the first day is one-third of caloric requirements, the second day is half of caloric requirements, the third day is 70-100% and sustained for 1 week. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day. Enteral nutrition is given through nasogastric tube or nasointestinal tube.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Age≥18 years
2. Definite diagnosis of acute stroke (GCS ≤12 or NIHSS≥11)
3. The randomized nutritional treatment could be initiated up to 72 hours after symptom onset.
4. Any cases of profiles #3 through 5 in Water Swallowing Test or with disorder of consciousness.
5. Plan to receive nutritional support treatment for at least 7 days.
6. Informed consent.

Exclusion Criteria

1. Receiving parenteral nutrition support
2. Contraindications of enteral nutrition
3. Complicated with the disease which only have life expectancy \< 7 days
4. Admission with infection signs
5. Dementia or severe disability (mRS\>4) before stroke
6. Antibiotics were used within the previous 7 days
7. Subarachnoid hemorrhage, cerebral arteriovenous malformation
8. Presence of coexisting medical conditions that could interfere with outcome assessment and/or follow-up (a. advanced cancer; b. severe pulmonary dysfunction \[forced expiratory volume in 1 second \< 50% or/and moderate to severe acute lung injury (PaO2/FiO2)\<200mmHg\]; c. cardiac insufficiency (NYHA class \> I; cardiac structural and/or functional abnormalities such as EF\< 50%, abnormal cardiac chamber enlargement, moderate/severe ventricular hypertrophy, or moderate/severe valvular stenosis); d. Severe liver failure \[Child-Pugh score≥7\]; e. Severe renal failure \[glomerular filtration rate ≤30mL/min or serum creatinine ≥4mg/dL\]
9. Currently participating in other clinical trial
10. Pregnant woman
11. Patient who is considered highly likely not to adhere to the study treatment or follow-up protocol.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tang-Du Hospital

OTHER

Sponsor Role collaborator

Xi'an Central Hospital

OTHER

Sponsor Role collaborator

Xi'an Gaoxin Hospital

OTHER

Sponsor Role collaborator

First Affiliated Hospital Xi'an Jiaotong University

OTHER

Sponsor Role collaborator

Xi'an No.3 Hospital

OTHER_GOV

Sponsor Role collaborator

First People's Hospital of Xianyang

OTHER

Sponsor Role collaborator

Nanfang Hospital, Southern Medical University

OTHER

Sponsor Role collaborator

Tongji Hospital

OTHER

Sponsor Role collaborator

Qilu Hospital of Shandong University

OTHER

Sponsor Role collaborator

The Second Hospital of Shandong University

OTHER

Sponsor Role collaborator

PLA 960 Hospital

UNKNOWN

Sponsor Role collaborator

Daping Hospital, The Third Military Medical University (Army Medical University)

UNKNOWN

Sponsor Role collaborator

The Second Affiliated Hospital of Guangzhou University of Chinese Medicine

UNKNOWN

Sponsor Role collaborator

First Hospital Affiliated to Zhengzhou University

UNKNOWN

Sponsor Role collaborator

Gansu Provincial Central Hospital

UNKNOWN

Sponsor Role collaborator

The First Hospital of Changsha City

UNKNOWN

Sponsor Role collaborator

Shaanxi Provincial People's Hospital

OTHER

Sponsor Role collaborator

Yulin No.2 Hospital

OTHER

Sponsor Role collaborator

Yulin No.1 Hospital

UNKNOWN

Sponsor Role collaborator

Xijing Hospital

OTHER

Sponsor Role collaborator

Wen Jiang-3

OTHER

Sponsor Role lead

Responsible Party

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Wen Jiang-3

Head of Neurology

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Chongqing University Three Gorges Hospital

Chongqing, Chongqing Municipality, China

Site Status RECRUITING

Daping Hospital, The Third Military Medical University

Chongqing, Chongqing Municipality, China

Site Status RECRUITING

Gansu Provincal Central Hospital

Lanzhou, Gansu, China

Site Status RECRUITING

Nanfang Hospital, Southern Medical University

Guangzhou, Guangdong, China

Site Status NOT_YET_RECRUITING

The Second Affiliated Hospital of Guangzhou University of Chinese Medicine

Guangzhou, Guangdong, China

Site Status RECRUITING

The Affiliated Hospital of Guizhou Medical University

Guiyang, Guizhou, China

Site Status RECRUITING

First Affiliated Hospital of Zhengzhou University

Zhengzhou, Henan, China

Site Status RECRUITING

Tongji Hospital

Wuhan, Hubei, China

Site Status RECRUITING

The First Hospital of Changsha City

Changsha, Hunan, China

Site Status NOT_YET_RECRUITING

The Second Affiliated Hospital of Nanchang University

Nanchang, Jiangxi, China

Site Status RECRUITING

General Hospital of Ningxia Medical University

Yinchuan, Ningxia, China

Site Status RECRUITING

Shaanxi Second Provincal People's Hospital

Xi'an, Shaanxi, China

Site Status RECRUITING

Tangdu Hospital

Xi'an, Shaanxi, China

Site Status NOT_YET_RECRUITING

The first affiliated hospital of Xi'an Jiaotong University

Xi'an, Shaanxi, China

Site Status RECRUITING

Xi'an Central Hospital

Xi'an, Shaanxi, China

Site Status NOT_YET_RECRUITING

Department of Neurology, Xijing Hospital

Xi'an, Shaanxi, China

Site Status RECRUITING

Shannxi Provincal People's Hospital

Xi'an, Shaanxi, China

Site Status NOT_YET_RECRUITING

The First Affiliated Hospital of Xi'an Medical University

Xi'an, Shaanxi, China

Site Status RECRUITING

Xi'an Gaoxin Hospital

Xi'an, Shaanxi, China

Site Status RECRUITING

Xi'an No.3 Hospital

Xi'an, Shaanxi, China

Site Status RECRUITING

Xianyang Hospital, Yan'an University

Xianyang, Shaanxi, China

Site Status RECRUITING

The First People's Hospital of Xianyang

Xianyang, Shaanxi, China

Site Status RECRUITING

Yulin No.1 Hospital

Yulin, Shaanxi, China

Site Status NOT_YET_RECRUITING

Yulin No.2 Hospital

Yulin, Shaanxi, China

Site Status NOT_YET_RECRUITING

Qilu Hospital of Shangdong University

Jinan, Shandong, China

Site Status NOT_YET_RECRUITING

The PLA 960 Hospital

Jinan, Shandong, China

Site Status RECRUITING

The Second Hospital of Shandong University

Jinan, Shandong, China

Site Status RECRUITING

Liaocheng People's Hospital

Liaocheng, Shandong, China

Site Status RECRUITING

People's Hospital of Xinjiang Uygur Autonomous Region

Ürümqi, Xinjiang, China

Site Status RECRUITING

The Second Affiliated Hospital of Xinjiang Medical University

Ürümqi, Xinjiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Wen Jiang, Ph.D

Role: CONTACT

86-029-84771319

Xuan Wang, MD

Role: CONTACT

86-029-84773664

Facility Contacts

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Shengli Chen

Role: primary

86-13896226960

Meng Zhang

Role: primary

Rong Yin

Role: primary

Suyue Pan

Role: primary

Lixin Wang

Role: primary

Mingyao You

Role: primary

86-13639091084

Wenjing Deng

Role: primary

Furong Wang

Role: primary

Hong Tan

Role: primary

Wei Huang

Role: primary

86-13677080198

Xueping Zhang

Role: primary

86-13639503586

Dong Huang

Role: primary

86-13759902540

Jun Guo, PhD

Role: primary

Kang Huo

Role: primary

86-15202971941

Zhengli Di, PhD

Role: primary

Wen Jiang, Ph.D

Role: primary

86-029-84771319

Hua Lv

Role: primary

Bei Zhang

Role: primary

Yi Jia

Role: primary

+86 13891996727

Mingze Chang

Role: primary

Wen Liu

Role: primary

86-18740505535

Liping Yu

Role: primary

Yongfeng Huang

Role: primary

Xue Li

Role: primary

Qinzhou Wang

Role: primary

Huaiqiang Hu

Role: primary

Wei Shang

Role: primary

Xinyuan Shang

Role: primary

86-15098430653

Hui Dang

Role: primary

86-13899978881

Xiaobei Wang

Role: primary

86-17699055500

References

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Uozumi M, Sanui M, Komuro T, Iizuka Y, Kamio T, Koyama H, Mouri H, Masuyama T, Ono K, Lefor AK. Interruption of enteral nutrition in the intensive care unit: a single-center survey. J Intensive Care. 2017 Aug 4;5:52. doi: 10.1186/s40560-017-0245-9. eCollection 2017.

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Reignier J, Boisrame-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, Argaud L, Asehnoune K, Asfar P, Bellec F, Botoc V, Bretagnol A, Bui HN, Canet E, Da Silva D, Darmon M, Das V, Devaquet J, Djibre M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Guerin C, Guidet B, Guitton C, Herbrecht JE, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Piton G, Quenot JP, Richecoeur J, Rigaud JP, Robert R, Rolin N, Schwebel C, Sirodot M, Tinturier F, Thevenin D, Giraudeau B, Le Gouge A; NUTRIREA-2 Trial Investigators; Clinical Research in Intensive Care and Sepsis (CRICS) group. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018 Jan 13;391(10116):133-143. doi: 10.1016/S0140-6736(17)32146-3. Epub 2017 Nov 8.

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Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, McKeever L. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):12-41. doi: 10.1002/jpen.2267. Epub 2022 Jan 3.

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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.

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Other Identifiers

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XJLL-KY-20222214

Identifier Type: -

Identifier Source: org_study_id

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