Critical Illness, Malabsorption Syndromes
Conditions
Keywords
Mechanically-ventilated, medical-surgical critically ill patients, reduced gastric motility
Brief summary
This is a multi-centre randomised controlled trial comparing early jejunal feeding (using a frictional nasojejunal \[NJ\] tube) and standard feeding in critical illness.
Interventions
PROCEDUREEarly jejunal feeding (using frictional NJ tube)
PROCEDUREStandard feeding (using nasogastric [NG] tube)
Sponsors
Bayside Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
ICU patients are eligible for enrolment if they meet all of the following: * Age \> 18 years old * In ICU for \< 48 hours prior to enrolment * Receiving invasive mechanical ventilation (through an endotracheal tube or tracheostomy, but NOT a facemask) with an anticipated need for \> 48 hours of mechanical ventilation * Receiving a continuous infusion of any one of: * morphine \> 2 mg/hour, * fentanyl \> 20 mcg/hour, or * pethidine \> 20 mg/hour * Either a single GRV \> 150 mls (whilst receiving EN via a NG tube) or nasogastric drainage \> 500 mls over 12 hours (whether receiving EN or not)
Exclusion criteria
Patients will be ineligible for enrolment if they meet any of the following: * Previous or recent surgery which has altered the anatomy of the upper gastrointestinal tract (eg. oesophagectomy, gastrectomy, any gastric anastomosis surgery, gastroplasty, pyloroplasty, pancreaticoduodenectomy \[Whipple's procedure\]) * Known gastric malignancy * Known oesophageal varices * Current admission for peptic ulceration * Current mechanical bowel obstruction * Current gastrostomy, jejunostomy, or surgically-placed enteral tube in situ * Contraindication to the use of the nose and mouth for enteral tube insertion (eg. recent facial trauma or surgery) * Receiving nutritional support prior to ICU admission * Severe coagulopathy (defined by platelet count \< 20 and/or international normalized ratio \[INR\] \> 4.0)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The amount of EN delivered during the Intensive Care Unit (ICU) stay | — |
Secondary
| Measure | Time frame |
|---|---|
| Daily cumulative proportion of EN delivered | — |
| Ventilator-associated pneumonia rate | — |
| Duration of mechanical ventilation | — |
| Amount of EN delivered during the first 10 days of the study | — |
| Mortality at hospital discharge | — |
| Success rate of placement into both the small bowel, generally, and the jejunum, specifically | — |
| Complication rates (as compared to the nasogastric tube) | — |
| Duration of hospitalisation | — |
Countries
Australia
Contacts
Primary ContactAndrew Davies
Backup ContactSiouxzy Morrison
Outcome results
None listed