- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03117348
Gradual Versus Immediate Goal-dose Enteral Nutrition in Abdominal Surgery Patients (GIGENAS)
September 21, 2020 updated by: Wang Xinying, Jinling Hospital, China
Gradual Versus Immediate Goal-dose Enteral Nutrition in Abdominal Surgery Patients: A Clinical Randomized Controlled Trial
Patients will be randomized to Gradual or immediate Goal-dose EN group at day 3 after abdominal surgery.
Patients will receive Goal-dose EN gradually or immediately after abdominal surgery.
Both groups will receive EN for 5 days except 80% of target energy delivered by oral feeding or patients are discharged from hospital.
The primary and secondary outcomes will be collected.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
Patients after abdominal surgery will receive enteral nutrition for 2 days, if she/he can tolerate 30% of goal-dose EN, then she/he will be randomized to Gradual or immediate Goal-dose EN group at day 3. Patients in Gradual Goal-dose EN group will receive increased calories gradually by EN and will reach the 80% of target energy by EN at day 8 while patients in immediate Goal-dose EN group will receive 100% of target energy by EN at day 3 after abdominal surgery.
Both groups will receive EN for 5 days except 80% of target energy delivered by oral feeding or patients are discharged from hospital, whichever arrives first.
The primary and secondary outcomes will be collected.
Study Type
Interventional
Enrollment (Actual)
411
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
-
-
Jiangsu
-
Nanjing, Jiangsu, China, 210002
- Jinling Hospital, China
-
-
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
18 years to 80 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Informed consent of patients or their legal representatives to participate in this study.
- patients undergoing selective operation without trauma
- patients following medium or major abdominal surgery
- NRS 2002≥ 3
Exclusion Criteria:
- Psychiatric disorders
- Pregnancy or breast-feeding women
Malnutrition
- Weight loss >10%-15% in 6 months
- BMI<18.5
- SGA score with stage C
- Albumin < 30g/L
- Unstable vital signs or unstable hemodynamics (such as systolic blood pressure < 90 mmHg or mean arterial pressure < 70 mmHg after rapid 500 ml crystal or 200 ml gel infusion, or the 50% increase of vascular active drug infusion rate in an hour, etc)
- Refuse to participate in the study
Mortality rates expected to more than 50% in 6 months with malignant or irreversibility diseases
- Cancer in terminal stage or
- HIV positive at end-stage or CD4 < 50/mm3
- Cardiopulmonary resuscitation (CPR) before cardiac arrest and nervous system function not fully recovery
- Four levels of physical activity of the patients defined by New York heart association
- Rely on breathing machine because of chronic diseases
- Life expectancy less than 24 hours of dying patients
Refractory shock to meet any of the following article
- The infusion rate of dopamine > 15 ug/kg/min
- The infusion rate of dobutamine > 15 ug/kg/min
- The infusion rate of epinephrine and norepinephrine > 30 ug/min
- The infusion rate of phenylephrine > 50 ug/min
- The infusion rate of milrinone > 0.5 ug/kg/min
- The infusion rate of vasopressin > 0.04 U/min
- Inter aortic ballon pump (IABP)
- Hepatic insufficiency (alanine/aspartate transaminase/bilirubin 200% above normal range)
- Renal insufficiency(creatinine 200% above normal range)
- Metabolic diseases(hyperthyroidism/ hypothyroidism, adrenal cortex disorders)
- EN can not reach 30% of target energy in 48 hours after surgery
- Burn area exceeding 20% of the patient's body surface
- Autoimmune diseases or immune dysfunction or history of organ transplantation
- International standardization ratio (INR) more than 3.0 or platelet count < 30000 cells/mm3 or other hemorrhagic diathesis
- Intracranial hemorrhage one month before enrolment
- General contraindications to infusion therapy or history of severe allergy against ingredients of enteral and parenteral nutrition
- Has already participated in another clinical trial
- Has started to nutritional support therapy before enrolment
- Diabetes mellitus (anamnestic and/or under medical treatment)
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 |
---|---|
Experimental: Gradual goal-dose EN
Patients in Gradual Goal-dose EN group will receive increased calories gradually by enteral nutrition and will reach the 80% of target energy by enteral nutrition at day 8.
|
Patients in Gradual Goal-dose EN group will receive increased calories gradually by EN and will reach the 80% of target energy by EN at day 8 while patients in immediate Goal-dose EN group will receive 100% of target energy by EN at day 3 after abdominal surgery.
Both of the two group will receive EN for 5 days except 80% of target energy delivered by oral feeding or patients are discharged from hospital, whichever arrives first.
|
Experimental: Immediate goal-dose EN
Patients in immediate Goal-dose EN group will reach the 100% of target energy by enteral nutrition at day 3 after abdominal surgery.
|
Patients in Gradual Goal-dose EN group will receive increased calories gradually by EN and will reach the 80% of target energy by EN at day 8 while patients in immediate Goal-dose EN group will receive 100% of target energy by EN at day 3 after abdominal surgery.
Both of the two group will receive EN for 5 days except 80% of target energy delivered by oral feeding or patients are discharged from hospital, whichever arrives first.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Morbidity of infection
Time Frame: From date of randomization until the date of infection from any cause, assessed up to 2 months.
|
Invasion of the host organism by microorganisms that can cause pathological conditions or diseases.
|
From date of randomization until the date of infection from any cause, assessed up to 2 months.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Actual calories intake
Time Frame: During the intervention, assessed up to 2 months.
|
The total energy patients received during the intervention.
|
During the intervention, assessed up to 2 months.
|
Scale the frequency of gastrointestinal intolerance
Time Frame: During the intervention, assessed up to 2 months.
|
Diarrhea, vomiting, abdominal distention or cramping and abdominal pain.
|
During the intervention, assessed up to 2 months.
|
Laboratory examination
Time Frame: At the date of patients enrollment and after intervention, assessed up to 2 months.
|
Albumin, pre-albumin, transferrin and retinol conjugated protein
|
At the date of patients enrollment and after intervention, assessed up to 2 months.
|
Length of stay in hospital
Time Frame: From date of operation until the date of patients discharged from hospital, assessed up to 12 months.
|
The length of patients stay in hospital
|
From date of operation until the date of patients discharged from hospital, assessed up to 12 months.
|
Mortality
Time Frame: From date of randomization until the date of death, assessed up to 2 months after patients discharged from hospital.
|
All deaths reported in all enrolled patients.
|
From date of randomization until the date of death, assessed up to 2 months after patients discharged from hospital.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Xinying Wang, MD, Jinling Hospital, China
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C, Meersseman P, Muller J, Vlasselaers D, Debaveye Y, Desmet L, Dubois J, Van Assche A, Vanderheyden S, Wilmer A, Van den Berghe G. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17. doi: 10.1056/NEJMoa1102662. Epub 2011 Jun 29.
- Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, Davies AR, O'Leary M, Solano T, Peake S; Early PN Investigators of the ANZICS Clinical Trials Group. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA. 2013 May 22;309(20):2130-8. doi: 10.1001/jama.2013.5124.
- Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, Grozovski E, Theilla M, Frishman S, Madar Z. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011 Apr;37(4):601-9. doi: 10.1007/s00134-011-2146-z. Epub 2011 Feb 22.
- Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, Thibault R, Pichard C. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013 Feb 2;381(9864):385-93. doi: 10.1016/S0140-6736(12)61351-8. Epub 2012 Dec 3.
- 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.
- Bauer P, Charpentier C, Bouchet C, Nace L, Raffy F, Gaconnet N. Parenteral with enteral nutrition in the critically ill. Intensive Care Med. 2000 Jul;26(7):893-900. doi: 10.1007/s001340051278.
- Desachy A, Clavel M, Vuagnat A, Normand S, Gissot V, Francois B. Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients. Intensive Care Med. 2008 Jun;34(6):1054-9. doi: 10.1007/s00134-007-0983-6. Epub 2008 Jan 22.
- Arabi YM, Tamim HM, Dhar GS, Al-Dawood A, Al-Sultan M, Sakkijha MH, Kahoul SH, Brits R. Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial. Am J Clin Nutr. 2011 Mar;93(3):569-77. doi: 10.3945/ajcn.110.005074. Epub 2011 Jan 26.
- Rice TW, Mogan S, Hays MA, Bernard GR, Jensen GL, Wheeler AP. Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med. 2011 May;39(5):967-74. doi: 10.1097/CCM.0b013e31820a905a.
- Braunschweig CA, Sheean PM, Peterson SJ, Gomez Perez S, Freels S, Lateef O, Gurka D, Fantuzzi G. Intensive nutrition in acute lung injury: a clinical trial (INTACT). JPEN J Parenter Enteral Nutr. 2015 Jan;39(1):13-20. doi: 10.1177/0148607114528541. Epub 2014 Apr 9.
- Charles EJ, Petroze RT, Metzger R, Hranjec T, Rosenberger LH, Riccio LM, McLeod MD, Guidry CA, Stukenborg GJ, Swenson BR, Willcutts KF, O'Donnell KB, Sawyer RG. Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial. Am J Clin Nutr. 2014 Nov;100(5):1337-43. doi: 10.3945/ajcn.114.088609. Epub 2014 Sep 3.
- Peake SL, Davies AR, Deane AM, Lange K, Moran JL, O'Connor SN, Ridley EJ, Williams PJ, Chapman MJ; TARGET investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Use of a concentrated enteral nutrition solution to increase calorie delivery to critically ill patients: a randomized, double-blind, clinical trial. Am J Clin Nutr. 2014 Aug;100(2):616-25. doi: 10.3945/ajcn.114.086322. Epub 2014 Jul 2.
- Petros S, Horbach M, Seidel F, Weidhase L. Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial. JPEN J Parenter Enteral Nutr. 2016 Feb;40(2):242-9. doi: 10.1177/0148607114528980. Epub 2014 Apr 3.
- Zhang L, Liu Y, Gao X, Zhou D, Zhang Y, Tian F, Gao T, Wang Y, Chen Z, Lian B, Hu H, Jia Z, Xue Z, Guo D, Zhou J, Gu Y, Gong F, Wu X, Tang Y, Li M, Jin G, Qin H, Yu J, Zhou Y, Chi Q, Yang H, Wang K, Li G, Li N, van Zanten ARH, Li J, Wang X. Immediate vs. gradual advancement to goal of enteral nutrition after elective abdominal surgery: A multicenter non-inferiority randomized trial. Clin Nutr. 2021 Dec;40(12):5802-5811. doi: 10.1016/j.clnu.2021.10.014. Epub 2021 Oct 30.
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)
April 15, 2017
Primary Completion (Actual)
December 24, 2018
Study Completion (Actual)
February 16, 2019
Study Registration Dates
First Submitted
March 30, 2017
First Submitted That Met QC Criteria
April 12, 2017
First Posted (Actual)
April 17, 2017
Study Record Updates
Last Update Posted (Actual)
September 22, 2020
Last Update Submitted That Met QC Criteria
September 21, 2020
Last Verified
September 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 201502022-21
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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