- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02528760
To Determine the Role of Prokinetics in Feed Intolerance in Critically Ill Cirrhosis
November 18, 2017 updated by: Institute of Liver and Biliary Sciences, India
To Determine the Role of Prokinetics in Feed Intolerance in Critically Ill Cirrhosis- A Randomized Placebo Controlled Study
- All patients with chronic liver disease admitted in ICU (Intensive Care Unit) to be screened.
- Patients fulfilling criteria for feed intolerance to be included in the study.
- Patients to undergo routine biochemical and hematological testing including CBC, KFT, LFT, PT/INR, electrolytes baseline and daily along with ABG (Arterial Blood gas) analysis.
- Patients with ascites to be tested for presence or absence of SBP (Spontaneous Bacterial Peritonitis).
- Cultures to be sent as based on clinical parameter of the patient.
- All correctable causes for intra abdominal hypertension to be corrected including electrolyte imbalance, grade III ascites, intra abdominal infection.
- Symptoms- Absent bowel sounds (BS)= no BS detected by auscultation. Vomiting/regurgitation= any visible regurgitation of gastric contents; Diarrhoea= liquid stool > or =3 times/day; Bowel distension= suspected clinically and radiologically confirmed; Large gastric residual volume (GRV) of >or =500 ml/24 h on a single day or > 200ml at any time of the day.
- Per abdomen findings to be checked daily including presence of bowel sounds, tenderness, development of abdominal distension, abdominal girth monitoring and abdominal pressure monitoring.
- Patients who develop feed intolerance will be included.
- Feed intolerance to be defined as per study definition (3 out of 5 symptoms).
- Measurement of GRV (Gastric residual volume) to be done at 4 hourly interval.
- Methods for measuring GRV by either gravity drainage by connecting a gastric tube to a drainage bag for 10min or by manual aspiration of content using a 50ml syringe.
- Once feed intolerance develop than every 6 hourly intra abdominal pressure monitoring and abdominal girth monitoring to be done (24)
- Intra bladder pressure to be measured using Foleys manometer technique (25).
- Pressure measured in cm of water to be converted into mm of Hg.
- X ray abdomen supine to look for bowel distension, defined as more than 3 cm for small bowel and more than 5 cm in large bowel.
- Development of intra abdominal hypertension based on intra abdominal pressure.
- Patient to be stratified according to the grade of intra-abdominal hypertension.
- After correction of all correctable causes, if feed intolerance persists, then patient to be randomized by block randomization method into 3 arms, metaclopromide group, erythromycin group or placebo group.
- Daily assessment of bowel sounds, abdominal pressure, abdominal girth every 6 hourly and gastric residual volume to be noted every 4 hourly.
- Response of therapy to be assessed at 24 hours in each arm.
- Response to be assessed by resolution of feed intolerance or initiation of entral nutrition.
- Metoclopromide to be given 10mg iv 8 hourly.
- Erythromycin to be given 70mg iv 12 hourly (26).
- Placebo arm to receive normal saline in 10ml syring twice daily.
- After 24 hours of treatment if symptoms do not resolve than rescue treatment will be given to each arm which may include continuation of prokinetics, add on prokinetic, flatus tube insertion for bowel decompression, upgradation of antibiotics or search for any other cause, as per the patient response.
- Therapy to continue for a total duration of 72 hours.
- If there is no response at 72 hours, than study stops.
- If patient responds to given treatment, study to continue for a total duration of 7 days.
- Assessment to continue in each arm for a maximum period of 7 days.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
83
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Delhi
-
New Delhi, Delhi, India, 110070
- Institute of liver and Biliary Sciences
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years to 68 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
1. Patients who develop new onset feed intolerance to enteral nutrition
Exclusion Criteria:
- Any patient with current or past surgical abdomen including mechanical obstruction, mesenteric ischemia, perforation or requiring abdominal surgery.
- Patients receiving enteral nutrition through gastrostomy or jejunostomy.
- Patients in whom, prokinetics are contraindicated or are allergic to the same.
- Patients who received prokinetic more than one day prior to the start of enteral feeding.
- Patients with uncontrolled sepsis with DIC.
- Requirement of two or more vasopressors.
- Organ failure requiring high inotropic support.
- Advanced cardiopulmonary disease, with prior history of arrhythmias, structural heart disease.
- History of traumatic brain injury, raised intracranial pressure, history of myasthenia gravis.
- Endocronolgic illnesses: Hypothyroidism, hypoparathyroidism
- Connective tissue diseases (systemic sclerosis, dermatomyositis or polymyositis, systemic lupus erythematosis, amyloidosis).
- Known case of diabetes with diabetic gastroparesis
- Pregnancy
- Patients or concerned family member who fail to give consent for study enrollment
- Age less than 18 years and more than 70 years.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo group
|
|
Experimental: Metaclopromide group
|
23. Metoclopromide to be given 10mg iv 8 hourly
|
Experimental: Erythromycin group
|
Erythromycin to be given 70mg iv 12 hourly.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Resolution of feed intolerance at 24 hours with improvement in 3 or more points and initiation of entral feeding.
Time Frame: 24 hours
|
Feed intolerance to be defined as 3/5 symptoms which include gastric residual volume > 500 ml /day,absence of bowel sounds,vomitting/regurgitation,diarrhoea and bowel distension
|
24 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Survival
Time Frame: 72 hours
|
72 hours
|
|
Survival
Time Frame: 7 days
|
7 days
|
|
Number of patients with Initiation of entral nutrition more than 50%. of recommended nutrition (Kcal/kg body weight/day).
Time Frame: 72 hours
|
Feed intolerance is also defined when entral nutrition provided < 20Kcal/kg body weight/day.
|
72 hours
|
Number of patients with resolution of atleast 2 out of 5 symptoms in all the 3 groups.
Time Frame: 72 hours
|
Feed intolerance to be defined as 3/5 symptoms which include gastric residual volume > 500 ml /day,absence of bowel sounds,vomitting/regurgitation,diarrhoea and bowel distension
|
72 hours
|
Number of patients with resolution of sepsis, shock, organ failure in all the 3 groups.
Time Frame: 7 days
|
7 days
|
|
Number of patients without Ventilatory support in all the 3 groups.
Time Frame: 7 days
|
7 days
|
|
Number of patients without inotropic supports in all the 3 groups.
Time Frame: 7 days
|
7 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 24, 2015
Primary Completion (Actual)
August 31, 2017
Study Completion (Actual)
August 31, 2017
Study Registration Dates
First Submitted
August 17, 2015
First Submitted That Met QC Criteria
August 18, 2015
First Posted (Estimate)
August 19, 2015
Study Record Updates
Last Update Posted (Actual)
November 21, 2017
Last Update Submitted That Met QC Criteria
November 18, 2017
Last Verified
September 1, 2016
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Liver Diseases
- Fibrosis
- Liver Cirrhosis
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Autonomic Agents
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Antiemetics
- Gastrointestinal Agents
- Anti-Bacterial Agents
- Dopamine Agents
- Dopamine D2 Receptor Antagonists
- Dopamine Antagonists
- Protein Synthesis Inhibitors
- Erythromycin
- Erythromycin Estolate
- Erythromycin Ethylsuccinate
- Erythromycin stearate
- Metoclopramide
Other Study ID Numbers
- ILBS-Cirrhosis-005
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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