- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06104527
Indicator Amino Acid Oxidation in ICU Patients (IAAO-IC)
The Effect of Standard or Higher Protein Feeding on Indicator Amino Acid Oxidation in ICU Patients
Study Overview
Status
Conditions
Detailed Description
Rationale:
While protein administration guidelines for critical care are available from international organizations such as ASPEN and ESPEN, they vary greatly in their recommended dose and are based on relatively low-quality evidence. The Indicator Amino Acid Oxidation (IAAO) technique has been developed as a more practical and non-invasive tool to assess protein metabolism that can be used in vulnerable populations. Application of the IAAO technique in patients admitted to the Intensive Care Unit (ICU) could provide an alternative to better investigate optimal protein feeding during critical illness.
Objective:
To assess the effect of enteral feeding with higher protein content compared to standard protein content on indicator amino acid oxidation in ICU patients.
Study design:
Randomized, counterbalanced, cross-over trial.
Study population:
Adult patients with an unplanned admission to the ICU, who are mechanically ventilated and have an indication for prolonged enteral nutrition.
Intervention:
Subjects will undergo two test days in randomized order during which they receive either enteral feeding according to a standard protein dose (1.3 g/kg/d) or a higher protein dose (2.0 g/kg/d). Continuous feeding of L-[1-13C]-phenylalanine combined with breath, urine and blood samples will be applied to assess indicator amino acid oxidation.
Main study parameters/endpoints:
The primary endpoint is indicator amino acid oxidation after enteral feeding with a standard or higher protein content, determined using the Indicator Amino Acid Oxidation (IAAO) method by measuring 13CO2 enrichment in expired breath and enrichment of L-[1-13C]-phenylalanine in plasma and urine.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness:
The overall risk of the study is negligible. The current study compares the effect of two nutritional compositions, that fall within the recommendations of international guidelines on ICU nutrition, on protein metabolism following ICU admission. To avoid overfeeding in the early phase of critical illness, both in terms of calories and protein, full enteral nutrition is provided after three days of gradual increase of intake (i.e., 25-50-75% of targeted intake, on days 1-2-3 respectively). Sampling of breath, urine, feces and plasma does not bring additional risks for this population. Our department has an extensive background in amino acid stable isotope methodology, assessment of 13CO2 enrichment in expired breath samples, and assessment of carbon dioxide production by indirect calorimetry.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Julia Bels, M.D.
- Phone Number: +316 30 48 06 85
- Email: julia.bels@mumc.nl
Study Contact Backup
- Name: Jorn Trommelen, Ph.D.
- Email: jorn.trommelen@maastrichtuniversity.nl
Study Locations
-
-
Limburg
-
Maastricht, Limburg, Netherlands, 6229 HX
- Recruiting
- Maastricht University Medical Center+
-
Contact:
- Julia Bels, M.D.
- Phone Number: +31630480685
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- ≥ 18 years old
- Unplanned admission to the ICU
- Mechanically ventilated
- Start of enteral nutrition within 2 days of intubation
- ≥ 3 days on enteral nutrition
- Expected remaining ICU stay on mechanical ventilation of ≥ 2 days
Exclusion Criteria:
- Contra-indication for enteral nutrition at the discretion of the treating physician
- Feeding intolerance during incremental feeding protocol
- Moribund or withholding of treatment
- On extracorporeal membrane oxygenation (ECMO)
- Presence of chest drains, pneumothorax, tracheoesophageal fistula or subcutaneous emphysema
- Kidney failure AND a "no dialysis"-code on admission
- Hepatic encephalopathy (West Haven criteria 3-4)
- BMI < 18 kg/m2
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: 1.3 g/kg/day followed by 2.0 g/kg/day
Patients in this arm will, on their first test day, receive enteral nutrition containing 1.3 grams of protein per kg of body weight per day followed by 2.0 grams of protein per kg of body weight per day on their second test day.
|
Enteral nutrition with standard (1.3 g/kg/d) protein provision, given via a nasogastric tube.
An oral L-[1-13C]-phenylalanine tracer is given as co-intervention.
Use of an enterally given tracer is necessary to determine indicator amino acid oxidation.
Enteral nutrition with high (2.0 g/kg/d) protein provision, given via a nasogastric tube.
An oral L-[1-13C]-phenylalanine tracer is given as co-intervention.
Use of an enterally given tracer is necessary to determine indicator amino acid oxidation.
|
Other: 2.0 g/kg/day followed by 1.3 g/kg/day
Patients in this arm will, on their first test day, receive enteral nutrition containing 2.0 grams of protein per kg of body weight per day followed by 1.3 grams of protein per kg of body weight per day on their second test day.
|
Enteral nutrition with standard (1.3 g/kg/d) protein provision, given via a nasogastric tube.
An oral L-[1-13C]-phenylalanine tracer is given as co-intervention.
Use of an enterally given tracer is necessary to determine indicator amino acid oxidation.
Enteral nutrition with high (2.0 g/kg/d) protein provision, given via a nasogastric tube.
An oral L-[1-13C]-phenylalanine tracer is given as co-intervention.
Use of an enterally given tracer is necessary to determine indicator amino acid oxidation.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Indicator amino acid oxidation
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission.
|
Indicator amino acid oxidation expressed as µmol/kg/h
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
13CO2 excretion in breath (F13CO2)
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Collected using breath samples; measured using gas chromatography-mass spectrometry (Agilent G1530N/G2589A, Little Falls, USA)
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Concentration of plasma phenylalanine
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Collected via in situ arterial catheter; analyzed using high performance liquid chromatography
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Fecal output and fecal protein content
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected from start of intervention until end of intervention & tracer protocol.
|
Collected via in situ fecal collection bag; protein content in fecal samples will be measured using Dumas method (Variomax CN-analyser)
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected from start of intervention until end of intervention & tracer protocol.
|
Enrichment of breath 13CO2
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Collected using breath samples; measured using gas chromatography-mass spectrometry (Agilent G1530N/G2589A, Little Falls, USA)
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
CO2 production
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected 2 hours after start of tracer protocol.
|
Measured using indirect calorimetry
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected 2 hours after start of tracer protocol.
|
Enrichments of plasma L-[1-13C]-phenylalanine
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Collected via in situ arterial catheter; measured using gas chromatography-mass spectrometry (Agilent G1530N/G2589A, Little Falls, USA)
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Enrichments of urine L-[1-13C]-phenylalanine
Time Frame: Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Collected via indwelling urinary catheter; measured using gas chromatography-mass spectrometry (Agilent G1530N/G2589A, Little Falls, USA)
|
Collected at standard vs higher protein administration, on test day 1 and 2 (depending on randomisation order), during the first week of ICU admission. Per test day: collected before start of tracer and at end of tracer protocol.
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Luc van Loon, Ph.D., Maastricht University
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- NL84098.000.23
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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