WE-FEED: How Well do we Feed the Critically Ill Patients
Study Details
Study Description
Brief Summary
The present prospective observational multicentric study will assess the nutritional status of critically ill patients, cumulative calorie and protein balance and the effect of calorie and protein balance on clinical outcomes.
Condition or Disease | Intervention/Treatment | Phase |
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Detailed Description
Nutritional therapy is a very important aspect of the management of critically ill patients. These patients need intensive monitoring, various organ supports in the form of vasopressors and inotropes, mechanical ventilation, dialysis, extracorporeal organ supports, infection controls, etc. In this very complex, critical and demanding scenario, nutritional therapy often gets a back seat in the initial period at least till the time patient is stabilised. But this nutritional deprivation has much more deleterious effects in sepsis and systemic inflammatory response syndromes induced catabolic state than that of fasting in healthy persons. Various studies showed that inadequate feeding has been associated with an increased hospital length of stay, incidence of complications, infections, incidence of organ failure, and risk of mortality. A single centre prospective study that analyzed 768 patients reported that 69% were calorie deficient and 90% were protein deficient. They also observed a positive correlation between calorie deficit and infectious complications, length of Intensive Care Unit (ICU) stay and days of mechanical ventilation.
The main factors may hinder enteral feeding and adequate nutrition delivery. That includes delay in the initiation of Enteral Nutrition (EN) and slow infusion rate; low adherence to EN practice guidelines; frequent disruptions to EN due to diagnostic or therapeutic procedures.
In observational studies, patients in the ICU who were fed early through the enteral route have had a better outcome than those who were not. Similarly, overfeeding has also been associated with various complications, including hyperglycemia, hypertriglyceridemia, hepatic steatosis, azotemia, hypercapnia, and an increased rate of mortality among patients.
Therefore, optimum nutrition is vital to a patient's survival. The present prospective observational multicentric study will assess the nutritional status of critically ill patients, cumulative calorie and protein balance and the effect of calorie and protein balance on clinical outcome
Study Design
Outcome Measures
Primary Outcome Measures
- Calorie and protein balance [From day of randomization till 7 days, or the patient is discharged from ICU, or death of the patient, whichever is earlier.]
Cumulative calorie and protein balance.
Secondary Outcome Measures
- Length of ICU stay [From the day of randomization till the patient is shifted out of ICU, or death of the patient, or 28 days of ICU admission, whichever is earlier.]
Correlation between initial nutritional status and calorie and protein deficit with length of ICU stay
- Days of Mechanical Ventilation [From day of randomization till the patient is removed from mechanical ventilation, or 28 days of ICU admission, or death of the patient, whichever is earlier]
correlation between initial nutritional status and calorie and protein deficit with days of mechanical ventilation
- Mortality [From the day of randomisation to 28 days of ICU admission.]
Correlation between initial nutritional status and calorie and protein deficit with mortality
- Time to initiation of enteral or parenteral nutrition [From the day of randomisation till 28 days of ICU admission, or death of the patient, whichever is earlier]
Time from ICU admission to initiation of enteral or parenteral nutrition
Eligibility Criteria
Criteria
Inclusion Criteria:
- All adult patients who receive either enteral or parenteral nutrition will be included in the study.
Exclusion Criteria:
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Age less than 18 years old
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Pregnant women
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Patient is expected to die within 48 hours of ICU admission.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | NMC Specialty Hospital, Al Nahda | Dubai | United Arab Emirates |
Sponsors and Collaborators
- NMC Specialty Hospital
- Banaras Hindu University
- All India Institute of Medical Science, Guntur
- All India Institute of Medical Science, Raipur, India
- Artemis Hospital, Gurugram, India
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, Delhi, India
- Dr Bhubaneswar Borooah Cancer Hospital, Guwahati, India
- Father Muller Medical College
- Fortis Hospital, India
- Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
- Mata Chanan Devi Hospital, Delhi, India
- North Eastern Indira Gandhi Regional Institute of Health ans Medical Sciences
- Rajiv Gandhi Cancer Institute & Research Center, India
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
- Amina Hospital, Ajman, United Arab Emirates
- Sri Guru Ram Institute of Medical & Health Science Shri Mahant Indiresh Hospital, Dehradun, India
Investigators
- Principal Investigator: Saurabh K Das, MD, Artemis Hospital, Gurugram, India
Study Documents (Full-Text)
None provided.More Information
Publications
- Bloomer MJ, Clarke AB, Morphet J. Nurses' prioritization of enteral nutrition in intensive care units: a national survey. Nurs Crit Care. 2018 May;23(3):152-158. doi: 10.1111/nicc.12284. Epub 2017 Jan 30.
- Ventura AM, Waitzberg DL. Enteral nutrition protocols for critically ill patients: are they necessary? Nutr Clin Pract. 2015 Jun;30(3):351-62. doi: 10.1177/0884533614547765. Epub 2014 Sep 23. Review.
- Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care. 2014 Dec 14;18(6):701. doi: 10.1186/s13054-014-0701-z.
- NMCSHFeeding