- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06089551
Early vs Postponed Parenteral Nutrition After Emergency Abdominal Surgery (EATERS)
Early Versus Postponed Supplementary Parenteral Nutrition After Major Emergency Abdominal Surgery: A Randomized, Controlled Multicenter Trial
The aim of this study is to investigate the effect of early, supplementary parenteral nutrition following emergency laparotomy.
Currently, parenteral nutrition is used in postoperative patients if or when oral or enteral nutrition is not feasible. However, little data exists on the optimal timing of parenteral nutrition.
Oral and enteral nutrition is encouraged. Participants will randomized on the second postoperative day if their calorie intake (oral + enteral) is below 30% of the calculated requirement. Patients will be randomized to early (postoperative day 2) or postponed (postoperative day 5) start of parenteral nutrition.
The combined oral + enteral + parenteral calorie target is 70-80% of the calculated requirement. Participants in the postponed group will be re-assessed on postoperative day 5, and if their calorie intake is less than 50% parenteral nutrition will be administered.
The intervention will continue until oral + enteral intake is at least 70% of the calculated requirement or the participant is at his/her habitual intake.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Screening for potential participants will be done using the patient records which includes primary procedure, age, NRS-2002 score, and total calorie intake within the last 24 hours. Only information needed to determine eligibility in this study will be noted ahead of informed consent.
Enteral or oral feeding is encouraged as soon as possible postoperatively for all patients unless they have contraindications for oral intake. If they have contraindications for oral intake they are excluded from participation (Appendix 2). The caloric target is set to 25 kcal/kg/day. For patients with a body mass index > 30 kg/m2 the target will be calculated using their weight at body mass index 25 kg/m2. Oral protein supplements are encouraged in all patients. Nutritional calculations and monitoring can be performed locally according to the participating centers' standard clinical practice by dieticians, nurses, or clinical doctors.
Patients that cannot achieve more than 30% of their calorie intake on POD2 and do not fulfill any of the exclusion criteria are randomized to early parenteral (E-SPN) (POD2) or postponed parenteral (L-SPN) (POD5). The L-SPN group will continue standard oral or enteral intake until POD5 where the parenteral nutritional intervention begins if they have not yet met at least 50% of recommended daily oral or enteral recommended intake on their own.
After randomization, the patients should receive 70-80% of recommended daily energy and protein intake. Calculations will be made daily by a combination of oral, enteral, and parenteral administered nutrition. In case of incomplete calorie intake registration, the most recent dose will be administered.
If patients are in need of supplemental parenteral nutrition for more than seven days, a centrally administered route should be used. The standard trial supplemental nutritional product will be SmofKabiven® Perifer unless there is a clinical rationale for using SmofKabiven. These include treatment duration > 7 days, risk of overhydration, calorie requirement exceeding the limit for SmofKabiven Perifer (1300 kcal). Both products will be used in accordance with the summary of product characteristics. Use of either product is not expected to impact data analysis as supplementary calorie amount is unrelated to the product.
Both investigational medicinal products (IMP) will be supplied by the local hospital pharmacy. All IMPs are stored in a dedicated medicine storage room located on each hospital ward. Handling IMPs will be in accordance with the regional guideline on the use of parenteral nutrition (Parenteral ernæring for voksne - procedure og forholdsregler, section 3 - vip.regionh.dk). The dosage is evaluated daily and is documented in the patient chart in Sundhedsplatformen (Epic Systems Corporation, Verona, Wisconsin) as is the time of infusion start.
Batch number and expiration date will be registered on a worksheet along with the end-infused dose. Worksheets will be stored in the Trial Master File.
Destruction of the IMP will be in accordance with local standards.
Patients will be monitored regarding complications, nutritional intake (calories, protein, lipids), and safety parameters (risk of overfeeding and refeeding) as standard.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Jannick B Hansen, M.D.
- Phone Number: +4538686862
- Email: jannick.brander.hansen@regionh.dk
Study Contact Backup
- Name: Jakob Burcharth, M.D., Ph.D
- Phone Number: +4538686568
- Email: jakob.burcharth@regionh.dk
Study Locations
-
-
-
Herlev, Denmark, 2730
- Recruiting
- Herlev Hospital
-
Contact:
- Jannick B Hansen, MD
- Phone Number: 38686862
- Email: jannick.brander.hansen@regionh.dk
-
Contact:
- Jakob Burcharth, MD
- Phone Number: 38686568
- Email: jakob.burcharth@regionh.dk
-
Principal Investigator:
- Jannick B Hansen, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age > 18
- Emergency primary midline laparotomy
- Preoperative NRS-2002 (nutritional risk screening) score < 7
- No contraindications for oral or enteral nutrition after surgery
- Unable to tolerate or take in at least 30% of calculated calorie requirement on postoperative day 2
- Capable of providing informed consent at the time of inclusion
Exclusion Criteria:
- Laparotomy without closure of the abdominal aponeurosis
- Non-midline incision
- Laparoscopic procedure
- Limiting mental or psychiatric disorders rendering participation unethical or unrealistic
- Patients with a very limited expected remaining time of living (< 3 months)
- Preoperative NRS-2002 = 7
- Pregnant or breastfeeding women
- Refusal to participate
- Emergency reoperations
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Early supplementary
Start of study drug on postoperative day 2
|
Participants will receive supplementary parenteral nutrition based on their calorie intake.
The dosage will be adjusted on a daily basis depending on intake.
Other Names:
|
Active Comparator: Late supplementary
Start of study drug on postoperative day 5
|
Participants will receive supplementary parenteral nutrition based on their calorie intake.
The dosage will be adjusted on a daily basis depending on intake.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Infectious complications during admission
Time Frame: 1 week after hospital discharge
|
Rate of infectious complications during admission.
The following infections will be registered: Urinary tract infections, pneumonia, bloodstream infections, surgical site infections, abdominal infections, and skin and soft tissue infections,
|
1 week after hospital discharge
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Non-infectious complication rate during admission
Time Frame: 1 week after hospital discharge
|
Stratified by type and severity (Clavien-Dindo classification)
|
1 week after hospital discharge
|
Days with need for antibiotics
Time Frame: 1 week after hospital discharge
|
Days the participant received antibiotic treatment
|
1 week after hospital discharge
|
Length of stay
Time Frame: Up to 30 days
|
Time from admission to discharge
|
Up to 30 days
|
Mortality rate (day 30, 90, and 180)
Time Frame: Assessed 180 days after surgery
|
Mortality at day 30, 90, and 180
|
Assessed 180 days after surgery
|
Emergency readmission rate (day 30, 90, and 180)
Time Frame: Assessed 180 days after surgery
|
Has the participant been re-admitted within 30, 90, or 180 days after surgery
|
Assessed 180 days after surgery
|
Post-discharge nutritional status
Time Frame: Assessed at day 30 and 90 after surgery
|
SNAQ (Simplified Nutritional Appetite Questionnaire) screening tool and weight at day 30 and 90.
A score between 5 and 20 is possible with a higher score being better.
|
Assessed at day 30 and 90 after surgery
|
Post-discharge weight status
Time Frame: Assessed at day 30 and 90 after surgery
|
Weight at day 30 and 90
|
Assessed at day 30 and 90 after surgery
|
Routes of energy delivery
Time Frame: Up to two weeks
|
Oral intake, enteral intake, parenteral intake or a combination of the three
|
Up to two weeks
|
Energy intake during admission
Time Frame: Up to two weeks
|
Measured in calories
|
Up to two weeks
|
Protein intake during admission
Time Frame: Up to two weeks
|
Measured in grams of protein
|
Up to two weeks
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jannick B Hansen, M.D., Copenhagen University Hospital at Herlev
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- The EATERS Trial
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
product manufactured in and exported from the U.S.
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.
Clinical Trials on Laparotomy
-
University Hospital, LimogesTerminatedExtended Ileal Resection Under Laparotomy | Total Proctocolectomy Under Laparotomy | Colectomy Left/Right/Total Under Laparotomy | Rectosigmoidal Resection Under Laparotomy | Anterior Resection of Rectum Under Laparotomy | Abdomino-perineal Amputation Under LaparotomyFrance
-
AbSolutions Med Inc.Cogent Technologies CorporationRecruiting
-
Centre Hospitalier Régional Metz-ThionvilleRecruiting
-
Mbarara University of Science and TechnologyCompleted
-
Seoul National University HospitalPharmbio Korea Co., Ltd.Completed
-
Riphah International UniversityNot yet recruiting
-
Pierre and Marie Curie UniversityUnknown
-
University of CopenhagenThe Danish Medical Research CouncilCompleted
-
Christian Medical College and Hospital, Ludhiana...Terminated
Clinical Trials on SmofKabiven
-
Fresenius KabiTerminatedCancer-related MalnutritionFrance
-
JW Life ScienceCompleted
-
JW Life ScienceCompleted
-
Fresenius KabiTerminatedCritical IllnessFrance, Germany, Poland
-
Rigshospitalet, DenmarkCompletedUrinary Bladder Neoplasms | Bladder Cancer | CystectomyDenmark
-
International Islamic University MalaysiaCompletedCritical IllnessMalaysia
-
Fresenius KabiParexelCompletedSurgery | Parenteral FeedingChina
-
Fresenius KabiCompletedCritical Illness | Nutrition TherapyRussian Federation
-
Fresenius KabiParexelCompletedSurgery | Parenteral NutritionChina
-
St. Petersburg State Pavlov Medical UniversityCompleted