Clinical Trial Details
— Status: Enrolling by invitation
Administrative data
NCT number |
NCT04437264 |
Other study ID # |
2000027328 |
Secondary ID |
|
Status |
Enrolling by invitation |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
July 7, 2020 |
Est. completion date |
December 2024 |
Study information
Verified date |
April 2024 |
Source |
Yale University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Evaluate effective delivery of goal nutrition with intermittent as compared with continuous
enteral nutrition schedules, as defined by percentage of recommended calories that patient
receives per day of interest.
Description:
Eligible patients will be approached and if the patient (or surrogate decision maker) is
interested, then consent will be obtained for participation in the study. The patient will
then be randomly assigned to receive usual care (continuous feeds) or intervention
(intermittent feeds, see details below). Randomization will occur via simple block
randomization within the REDCap software. Group assignment will not be revealed to the
clinical team until the decision to feed the patient has occurred and the actual feeding
order is entered. When the clinical team decides to initiate enteral nutrition, they will
place a nutrition consult order for tube feed recommendations. Nutrition consult will place
recommendations for both continuous feeding and for intermittent schedule, including enteral
nutrition formula and dosing. Prior to feeds being started, the patient's randomization
status will be revealed to the clinical team. The covering provider will then place the order
for enteral nutrition according to the nutritionist's recommendations for the correct feeding
schedule.
For patients randomized to continuous feeds, their enteral nutrition will be ordered and
delivered as per usual care and standard MICU procedure. Nutritionist will provide
recommendations for initiation rate, up titration schedule, and maintenance dosing to be
delivered continuously over 24 hours. Under usual care of ICU patients, our clinical
nutritionists provide a specified formula, a specified calorie goal, and a suggested
titration rate. This is typically 20 mL per hour to start with an increase in rate of 20 mL
per hour every 6 to 8 hours until the goal rate is achieved. Typical goal rates are in the
range of 60 to 80 mL per hour for 24 hours per day.
For patients randomized to the intervention group (intermittent feeds), they will receive
their enteral nutrition according to a research protocol schedule. This will involve the
total recommended feed volume divided into four equal volume "meals." These will be delivered
at a rate of 400 cc/hr at 8:00, 12:00, 16:00, and 20:00. The up-titration schedule will be as
follows: first meal will be 100 mL, and the volume of each meal thereafter will be increased
by 100mL until patient is at goal volume (typically between 300 and 450 mL). There are no
formula or diets that are inappropriate to be administered on an intermittent feed schedule.
The intervention will not change formula selection or total calorie goals. It will only
change the schedule of feeding. For all patients, regardless of feeding schedule, the
Kangaroo E-Pump will be used to deliver enteral nutrition, and the above rate and volume
parameters can be programmed in.
There will be no change in delivery of enteral free water or medications. This schedule will
be determined by nursing and clinical care team, as is the current standard of care. To
assure correct ordering of intermittent feeds and the insulin prior to each meal, an EPIC
orderset with prepopulated instructions will be developed.
If there are no signs of or clinical concerns for intolerance, patients will continue to
receive enteral nutrition according to assigned schedule until they are extubated or until
enteral nutrition is discontinued.