Interpretation and Optimization of Nutrition in the Intensive Care Units
ConditionNutritional Support
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorDim3
About this trial
Despite recommendations, inadequate nutritional intake in intensive care unit (ICU) patients remains frequent and can lead to complications such as infections, increased length of stay, prolonged weaning from ventilation, increased long-term mortality, and decreased quality of life after intensive care. Studies have shown that patients only receive up to 50-60% of prescribed calories and proteins due to many factors leading to nutritional support interruptions such as ICU procedures, physical therapy, transport for imaging or invasive procedures outside the ICU, and nutrition intolerance.
Furthermore, this discrepancy between prescribed and delivered nutrition may go largely unnoticed, due to issues concerning inadequate manual or automated monitoring of delivered nutrition. A joint "Call to Action" by ASPEN, the Academy of Nutrition and Dietetics, and the American Society of Health-System Pharmacists stated that parenteral nutrition errors and their contributing factors could be prevented by improving the functionality of in-house Clinical Decision Support Systems and the interfaces between electronic health records (EHRs), automated preparation devices and pharmacy systems.
Nutrow® is a software package designed to support nutritional management based on the calculation of recommended calorie and protein requirements, real-time calculation and monitoring of calorie and protein prescriptions, real-time calculation and monitoring of calories and protein truly delivered to patients, and information feedback to prescribers. Feedim® is a Medical Device Data System (MDDS), designed by Dim3, which transmits information from enteral feeding pumps to third-party software, such as Nutrow®.
The aim of the study is to assess whether the joint use of Nutrow-Feedim improves the achievement of nutritional objectives in ICU patients prior to oral intake by reducing the discrepancy between prescribed and delivered calories and protein.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age 18 and over.
French Social Security system registration.
First stay in ICU
Admitted to the Lille University Hospital Surgical ICU for at least 3 days.
Disqualifiers
Age under 18
Burn patient
Admitted to the ICU with a prior active enteral/parenteral nutritional support before day 3, except trophic nutrition
Dying patient, not-to-be-resuscitated order, or other treatment limitation decision at ICU admission
Trial design
Design model
Parallel
Treatments tested in this trial
Nutritional support prescription and delivery monitoring feedback
DeviceReal-time availability in an integrated computer interface (Nutrow) of all clinical and biological information related to nutritional support including recommended, prescribed, and delivered calories and proteins and enteral feed delivery transmitted by the Feedim medical device
Usual care
DeviceUsual use of standard clinical and biological information related to nutritional support as available through the ICU electronic health record (i.e. without any calculated information on recommended, prescribed, or received calories and protein, only information on prescribed products and volumes as collected by and presented in the ICU EHR) In this arm, participants, investigators, and healthcare professionals will be blinded to real-time enteral feed volumes that will be collected by the Feedim medical device and transmitted to the electronic study case report form.
Treatment groups
144 Participants
are divided into 2 treatment groupsGroup A: InterventionalExperimental treatment 1 intervention
Group B: controlOther 1 intervention
Trial outcomes
Primary outcomes
1
Mean total daily calories delivered/prescribed ratio (percent)
Total (enteral+parenteral) prescribed and delivered calories are measured daily (kcal/day). The ratio of mean total daily delivered calories over the study period divided by the mean total daily prescribed calories over the study period will be calculated and expressed as a %
Time frame
From ICU Day 3 to Day 28 or until any of the following if before day 28: Return to oral intake Discharge from the ICU DeathSecondary outcomes
1
Mean total daily protein delivered/prescribed ratio (%)
Total (enteral+parenteral) prescribed and delivered protein are measured daily (g/day). The ratio of total mean daily delivered protein over the study period divided by the mean total daily prescribed protein over the study period will be calculated and expressed as a %
Time frame
From ICU Day 3 to Day 28 or until any of the following if before day 28: Return to oral intake Discharge from the ICU Death2
Mean total daily calories delivered/recommended ratio (percent)
Total (enteral+parenteral) prescribed and delivered calories are measured daily (kcal/day). The ratio of mean total daily delivered calories over the study period divided by the mean total daily recommended calories (according to guidelines) over the study period will be calculated and expressed as a %
Time frame
From ICU Day 3 to Day 28 or until any of the following if before day 28: Return to oral intake Discharge from the ICU Death3
Mean total daily protein delivered/recommended ratio (percent)
Total (enteral+parenteral) prescribed and delivered protein are measured daily (g/day). The ratio of mean total daily delivered protein over the study period divided by the mean total daily recommended protein (according to guidelines) over the study period will be calculated and expressed as a %
Time frame
From ICU Day 3 to Day 28 or until any of the following if before day 28: Return to oral intake Discharge from the ICU Death4
Nutritional support duration (days)
Days on nutritional support (either parenteral and/or enteral) over the study period
Time frame
From ICU Day 3 to Day 28 or until any of the following if before day 28: Return to oral intake Discharge from the ICU DeathSponsors and contacts
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Source ClinicalTrials.gov