- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03292237
Intensive Nutrition in Critically Ill Adults (INTENT)
Intensive Nutrition Therapy Compared to Usual Care in Critically Ill Adults: A Randomised Pilot Trial
Despite the widespread use of nutrition therapy, no large scale randomized controlled trials (RCTs) have demonstrated positive outcomes with delivery of nutrition therapy early in critical illness, with some showing no effect with delayed nutrition or even harm.
There are several possible reasons for the lack of observed benefit from RCTs to date; interventions have been short in duration (usually 3-10 days after intensive care unit (ICU) admission), perhaps applied at the incorrect time in regards to the patients metabolism and recovery, do not consider the patients nutrition risk, and have not addressed what happens to nutrition intake post ICU in critically ill individuals. This may explain why RCTs to date have not observed any positive associations with the delivery of nutrition; our focus to date may have been on the wrong stage of illness. A future study is thus urgently needed, which addresses the deficiencies in current RCTs by optimizing nutrition delivery for the whole hospital stay and collecting meaningful clinical, process and outcome data, which will potentially inform a larger trial of a similar nature.
This initial study aims to determine whether optimization of energy using a pre-tested supplemental parenteral nutrition (PN) strategy in the Intensive Care Unit (ICU) and an intensive nutrition intervention in the post ICU period will deliver more total energy than standard nutrition care during hospital admission in a group of critically ill patients with at least one organ system failure.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background:
Nutrition is a commonly provided therapy in critical illness, but data about effectiveness is sparse. Best practice guidelines recommend enteral nutrition (EN), a specialised solution delivered into the gastrointestinal tract, as the first line of nutrition therapy. The majority of best practice guidelines also recommend delivery of energy and protein amounts close to predicted requirements in critical illness over the course of Intensive Care Unit (ICU) admission, however the only evidence to support this is from observational data. Although recommended that energy and protein requirements be met, and observational data suggests this is of benefit, there are practical challenges with the provision of EN. International practice surveys report the average energy and protein provided is approximately 59% of the patients predicted requirements, for multifactorial reasons. The addition of parenteral (intravenous) nutrition has been proposed as a method to provide additional energy when EN is insufficient, termed supplemental parenteral nutrition (PN). The ability of this strategy to deliver additional energy and protein to patients during critical illness has been proven in several feasibility/pilot trials, but the benefit on clinical and functional outcomes is unknown.
Despite observational data suggesting benefit when energy and protein delivery is optimised close to requirements, no large scale randomised controlled trials (RCTs) have confirmed improved clinical outcomes in critical illness, with some showing no effect with delayed nutrition or even harm. There are several possible reasons for the lack of observed benefit from RCTs to date; the interventions may have been applied at a time when the patient's metabolism is not in a phase of recovery; interventions have been short in duration and; studies have not addressed what happens to nutrition intake in the post ICU period of hospitalisation in critically ill individuals.
Aims:
To determine whether the use of a pre-tested supplemental PN strategy in the ICU and an intensive nutrition intervention after discharge to the hospital ward is feasible and will deliver more total energy than standard nutrition care over the entire hospital stay, in critically ill patients with at least one organ system failure.
A further aim is to develop a research program that will determine whether optimisation of energy to critically ill patients over the entire period of hospitalisation improves clinically-meaningful outcomes.
Hypothesis:
In critically ill patients with at least one organ failure, the use of a supplemental PN strategy in ICU and an intensive nutrition intervention on the hospital ward will lead to an increase in daily energy delivery of at least 15% over the entire hospital stay when compared to standard care.
Fifteen percent has been estimated as the minimum acceptable clinical difference between the two groups.
Objectives:
The major objectives are:
- To determine whether the whole hospital nutrition intervention leads to increased amounts of total energy delivered over the period of hospital stay
- To determine if the whole hospital nutrition intervention is safe in regards to adverse effects
- To determine if the post-ICU nutrition intervention is practically feasible when applied in multiple hospitals, across multiple wards
- To measure the clinical outcomes in patients and provide information to assist design of a larger randomised controlled trial
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Emma Ridley, PhD
- Phone Number: +614399030350
- Email: emma.ridley@monash.edu
Study Contact Backup
- Name: Eliza Miller, PhD
- Phone Number: +614399030217
- Email: Eliza.Miller@monash.edu
Study Locations
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New South Wales
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Blacktown, New South Wales, Australia, 2148
- Blacktown Hospital
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Kingswood, New South Wales, Australia, 2747
- Nepean Hospital
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Northern Territory
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Darwin, Northern Territory, Australia, 0810
- Royal Darwin Hospital
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Queensland
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Brisbane, Queensland, Australia, 4032
- Prince Charles Hospital
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Redcliffe, Queensland, Australia, 4020
- Redcliffe Hospital
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South Brisbane, Queensland, Australia, 4101
- Mater Hospital
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Southport, Queensland, Australia, 4215
- Gold Coast University Hospital
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Woolloongabba, Queensland, Australia, 4102
- Princess Alexandra Hospital
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South Australia
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Elizabeth Vale, South Australia, Australia, 5112
- Lyell McEwin
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Woodville South, South Australia, Australia, 5011
- Queen Elizabeth Hospital
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Victoria
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Ballarat, Victoria, Australia, 3350
- Ballarat Hospital
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Bendigo, Victoria, Australia, 3550
- Bendigo Hospital
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Epping, Victoria, Australia, 3076
- Northern Hospital
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Frankston, Victoria, Australia, 3199
- Frankston Hospital - Peninsula Health
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Geelong, Victoria, Australia, 3220
- Geelong Hospital
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Heidelberg, Victoria, Australia, 3084
- Austin Hospital
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Melbourne, Victoria, Australia, 3168
- Monash Medical Centre
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Melbourne, Victoria, Australia, 3004
- The Alfred Hospital
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Melbourne, Victoria, Australia, 3128
- Box Hill Hospital
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Melbourne, Victoria, Australia, 3121
- Epworth Richmond
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Melbourne, Victoria, Australia, 3010
- Royal Melbourne Hospital
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-
-
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Auckland, New Zealand, 2025
- Middlemore Hospital
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Auckland, New Zealand, 1023
- Auckland City Hospital CVICU
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion criteria
Patients in intensive care who meet all of the following will be eligible:
- Admitted to intensive care between 72 hours and 120 hours
- Receiving invasive ventilator support
- At least 18 years of age
- Have central venous access suitable for PN solution administration
Have 1 or more organ system failure (respiratory, cardiovascular or renal) related to their acute illness defined as:
- PaO2/FiO2 ≤ 300 mmHg
Currently on 1 or more continuous inotrope/vasopressor infusion which were started at least 4 hours ago at a minimum dose of:
- Noradrenaline ≥ 0.1mcg/kg/min
- Adrenaline ≥ 0.1 mcg/kg/min
- Any dose of vasopressin
- Milrinone > 0.1 mcg/kg/min
Renal dysfunction defined as:
- Serum creatinine 2.0-2.9 times baseline OR
- Urine output 0.5ml/kg/hr for ≥ 12 hours OR
- Currently receiving renal replacement therapy
- Currently has an intracranial pressure monitor or ventricular drain in situ
Exclusion criteria
Patients will be excluded if:
- Both EN and PN cannot be delivered at enrolment (i.e. either an enteral tube or a central venous catheter cannot be placed or clinicians feel that EN or PN cannot be safely administered due to any other reason)
- Currently receiving PN
- Clinician believes a specific parenteral formula is indicated
- Death is imminent in the next 96 hours
- There is a current treatment limitation in place or the patient is unlikely to survive to 6 months due to underlying/chronic illness
- More than 80% of energy requirements have been satisfactorily delivered via the enteral route in the last 24 hours
- Dialysis dependent chronic renal failure
- Suspected or known pregnancy
- Product contraindication
- The treating clinician does not believe the study to be in the best interest of the patient
Study Plan
How is the study designed?
Design Details
- Primary Purpose: SUPPORTIVE_CARE
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
NO_INTERVENTION: Standard Nutrition Arm
In ICU:
After ICU:
|
|
EXPERIMENTAL: Intensive Arm
Intervention In ICU:
After ICU: An intensive nutrition intervention will be provided on the ward in the intervention group. This will include daily review from dedicated study dietitians and a clearly protocolized hierarchical management plan which reflects best practice clinical management. |
Supplemental parenteral nutrition OLIMEL N12E (Baxter Healthcare Corporation)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Daily energy delivered from nutrition therapy
Time Frame: Day 28
|
Daily energy delivered from nutrition therapy
|
Day 28
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Nutrition intake
Time Frame: Day 28
|
Daily protein intake, Energy and protein intake by location (ICU and ward)
|
Day 28
|
Duration hospital stay
Time Frame: Day 28
|
Duration of hospital stay in survivors and non-survivors
|
Day 28
|
Ventilator Free Days
Time Frame: Day 28
|
Ventilator Free Days (VFDs) at study day 28
|
Day 28
|
Total blood stream infection rate
Time Frame: Day 28
|
Total blood stream infection rate
|
Day 28
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Duration of ICU stay
Time Frame: Day 28
|
Duration of ICU stay in survivors and non survivors
|
Day 28
|
Duration of Mechanical Ventilation
Time Frame: Day 28
|
Duration of Mechanical Ventilation to study day 28 in survivors and non-survivors
|
Day 28
|
ICU mobility scale
Time Frame: Day 28
|
ICU mobility scale at ICU discharge
|
Day 28
|
Mortality
Time Frame: Day 28
|
In hospital and 28 day mortality
|
Day 28
|
Blood stream infections
Time Frame: Day 28
|
Number of blood stream infections to day 28, time to any blood stream infection
|
Day 28
|
Weight
Time Frame: Day 28
|
Weight at hospital discharge
|
Day 28
|
Frailty
Time Frame: 90 days
|
Clinical frailty score
|
90 days
|
European Quality Of Life 5 Dimensions 5 Level (EQ5D-5L)
Time Frame: 90 days
|
Health related quality of life assessment using EQ5D-5L.
Each dimension has 5 levels ranging from no problems (1) to extreme problems (5), there is no overall score.
It also has a visual analogue scale (VAS) ranging 0-100 with 0 being worst imaginable health state and 100 being best imaginable health state
|
90 days
|
World Health Organization Disability Assessment Schedule 2.0 (WHODAS)
Time Frame: 90 days
|
WHODAS is a 12 point disability assessment with a raw score range of 0-48.
0 is no disability and 48 being full disability
|
90 days
|
European Quality Of Life 5 Dimensions 5 Level (EQ5D-5L)
Time Frame: 180 days
|
Health related quality of life assessment using EQ5D-5L.
Each dimension has 5 levels ranging from no problems (1) to extreme problems (5), there is no overall score.
It also has a visual analogue scale (VAS) ranging 0-100 with 0 being worst imaginable health state and 100 being best imaginable health state
|
180 days
|
World Health Organization Disability Assessment Schedule 2.0 (WHODAS)
Time Frame: 180 days
|
WHODAS is a 12 point disability assessment with a raw score range of 0-48.
0 is no disability and 48 being full disability
|
180 days
|
Cost per quality adjusted life year
Time Frame: 180 days
|
Cost per quality adjusted life year (QALY)
|
180 days
|
Cost per life year gained
Time Frame: 180 days
|
Cost per life year gained (LYG)
|
180 days
|
Frailty
Time Frame: 180 dyas
|
Clinical frailty score
|
180 dyas
|
Collaborators and Investigators
Collaborators
Publications and helpful links
General Publications
- Ridley EJ, Bailey M, Chapman M, Chapple LS, Deane AM, Hodgson C, King VL, Marshall A, Miller EG, McGuinness SP, Parke R, Udy AA; the Australian and New Zealand Intensive Care Society Clinical Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group. Protocol summary and statistical analysis plan for Intensive Nutrition Therapy comparEd to usual care iN criTically ill adults (INTENT): a phase II randomised controlled trial. BMJ Open. 2022 Mar 8;12(3):e050153. doi: 10.1136/bmjopen-2021-050153.
- Ridley EJ. Parenteral nutrition in critical illness: total, supplemental or never? Curr Opin Clin Nutr Metab Care. 2021 Mar 1;24(2):176-182. doi: 10.1097/MCO.0000000000000719.
- Ridley EJ, Parke RL, Davies AR, Bailey M, Hodgson C, Deane AM, McGuinness S, Cooper DJ. What Happens to Nutrition Intake in the Post-Intensive Care Unit Hospitalization Period? An Observational Cohort Study in Critically Ill Adults. JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):88-95. doi: 10.1002/jpen.1196. Epub 2018 Jun 20.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- ANZIC-RC/ER001
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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