None listed
Conditions
Brief summary
A recent large randomized trial has shown that a later start with supplementary parenteral nutrition when enteral nutrition is not working in full reduces ICU patient’s disease and length of ICU treatment. This has been shown in both adult and pediatric ICU patients. It has been hypothesized from these trails, that the early supplementary parenteral nutrition inhibits autophagy in cells. Autophagy is the cellular process that degrades larger proteins and organelles especially when they are damaged. The hypothesized inhibition of the autophagy process will then lead to the buildup of more damaged proteins and prolong/worsen the cellular and thereby organ function. At the pediatric ICU management, has decided to change the routine from early supplementary parenteral nutrition (day 2) to a later day (day 5) based on the clinical outcome trials. We will use this change to investigate the effect of initiating early feeding and later feeding on the potential of the patient’s serum to inhibit the autophagy flux in an in vitro model. There are no methods available to measure the autophagy flux in vivo in humans. In addition, we will relate the changes in autophagy flux to nutrients concentrations and clinical parameters.
Interventions
Supplementary parenteral nutrition when enteral nutrition is not up to target on day 5
Nutritional target is defined as: energy target according to Schofield equation.
For enteral nutrition different formulas are used depending on age and are given continuously either via nasogastric or post-pyloric tube (decided by the treating clinician).
Supplementary parenteral nutrition is given as different commercial formulas (Baxter): Numeta G16E (<10 kg body weight); Numeta G19E (10-15 kg body weigh
Supplementary parenteral nutrition when enteral nutrition is not up to target on day 5 Nutritional target is defined as: energy target according to Schofield equation. For enteral nutrition different formulas are used depending on age and are given continuously either via nasogastric or post-pyloric tube (decided by the treating clinician). Supplementary parenteral nutrition is given as different commercial formulas (Baxter): Numeta G16E (<10 kg body weight); Numeta G19E (10-15 kg body weight) and Olimel N5 (>15kg body weight). The amount given is: 67% of total nutritional target on day 5-6; 85% of total nutritional target on day 7-8 and 100% of total nutritional target from day 9 as long as in the ICU. The intervention is ordinated by treating clinician and administered by treating nurse.
Sponsors
Urban Fläring
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
No minimum to 18 Years
Healthy volunteers
No
Inclusion criteria
Treated at pediatric ICU; ongoing mechanical ventilation; Two or more failing organs; expected ICU stay of more than 2 days
Exclusion criteria
No informed consent
Outcome results
None listed