Surgery Clinical Trial
— PASTDUeOfficial title:
The PASTDUe Nutrition EcoSystem Pathway In Acute Care Abdominal Surgery and Trauma to Decrease Underfeeding and Complications
This is a research study to determine if a particular method of providing nutrition improves the clinical outcomes of patients in the intensive care unit (ICU) who have undergone abdominal surgery and would require nutrition delivered via the bloodstream (called total parenteral nutrition or TPN). The nutrition method we are testing is a structured nutrition delivery plan that involves tube feeding, oral nutrition supplements, and the use of a device (called an indirect calorimeter or IC) to measure calorie needs. This study will also use two devices to measure fat and muscle mass to examine changes during hospitalization. Subjects will be followed throughout hospitalization where nutrition status and fat and muscle mass will be closely monitored. Study activities will begin within 72 hours of a patient's abdominal surgery. TPN (total parenteral nutrition, a method of feeding that bypasses the usual process of eating and digestion) will be started, a non-invasive method of assessing calorie needs (indirect calorimetry (IC)) will be started, a urine sample will be collected to help assist in protein needs, and fat/muscle mass will be measured using bioelectrical impedance analysis (BIA), and an ultrasound. This is a minimal risk study and all products/devices used are non-invasive and FDA-approved. Indirect calorimetry and urine sample collection will be conducted every 3 days during the stay in the Intensive Care Unit - ICU, then every 5 days until hospital discharge. BIA and muscle ultrasound will be conducted every 7 days during ICU stay, then every 14 days until hospital discharge.
Status | Recruiting |
Enrollment | 300 |
Est. completion date | January 1, 2026 |
Est. primary completion date | January 1, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: 1. Age >= 18 years 2. ICU admission with major abdominal trauma, intra-abdominal sepsis, ischemic bowel/vascular emergencies, or penetrating trauma 3. Not expected to receive oral or enteral nutrition for > 72 hours 4. Primary team approval of PN 4. < 72 hours post-operative intervention Exclusion Criteria: 1. Expected death or withdrawal of life-sustaining treatment within the first 72 hours of ICU admission 2. Patients admitted with - Diabetic ketoacidosis or non-ketotic hyperosmolar coma - MELD > 20 or acute fulminant hepatic failure 3. Patients allergic to any component of parenteral nutrition or lipid solution 4. Pregnant or breastfeeding patients 5. Incarcerated or prisoner prior to admission |
Country | Name | City | State |
---|---|---|---|
United States | Duke University Medical Center | Durham | North Carolina |
Lead Sponsor | Collaborator |
---|---|
Duke University |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of nosocomial infection complications as measured by medical record review | From TPN initiation, daily until hospital discharge (up to 8 months) | ||
Primary | ICU length of stay in days measured by medical record review | From TPN initiation, daily until hospital discharge (up to 8 months) | ||
Secondary | Incidence of protein-calorie malnutrition measured using AND/ASPEN-defined malnutrition criteria | Measured daily from hospital admission to hospital discharge (up to 8 months) | ||
Secondary | Number of days patient is on ventilator measured by medical record review | Measured daily from hospital admission up to hospital discharge (up to 8 months) | ||
Secondary | Number of patients discharged home measured by medical record review/patient report | Recorded at hospital discharge (up to 8 months)] | ||
Secondary | Number of patients discharged to rehabilitation center measured by medical record review/patient report | Recorded at hospital discharge (up to 8 months)] | ||
Secondary | Number of patients discharged to nursing home measured by medical record review/patient report | Recorded at hospital discharge (up to 8 months)] | ||
Secondary | ICU length of stay in days measured by medical record review | Measured from ICU admission to ICU discharge (up to 8 months) | ||
Secondary | Length of hospital stay in days as measured by medical record review | Measured from hospital admission to hospital discharge (up to 8 months) | ||
Secondary | Incidence of ED/hospital utilization as measured by medical record review/patient report | Measured from hospital discharge to 1-year post-hospital discharge] | ||
Secondary | Number of TPN-related complications as measured by medical record review/patient report | Measured from TPN initiation until completion of TPN course/treatment (up to 8 months) | ||
Secondary | Number of the different types of TPN-related complications as measured by medical record review/patient report | Measured from TPN initiation until completion of TPN course/treatment(up to 8 months) | ||
Secondary | Number of deaths in 1-year as measured by medical record review/Legally Authorized Representative report | Measured from hospital discharge to 1-year post-hospital discharge] |
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