Gastrointestinal Dysfunction, Critical Illness, Nutrition Disorders
Conditions
Keywords
gastrointestinal function, enteral feeding, critical
Brief summary
The intestine is the most vulnerable target organ in septic patients and is the first to be damaged organ in multiple organ dysfunction syndrome(MODS).Therefore, improving intestinal motility and mucosal barrier function is critical to the treatment of sepsis. Many studies have shown that, early enteral nutrition(EN) in patients with sepsis helps prevent and treat intestinal dysfunction, reducing ICU mortality and length of stay in ICU. However, there is little research on feeding methods. In this study the investigators will compare the outcomes of different feeding methods: continuously-pumped in 24 hours, continuouslypumped in 16 hours and intermittently-pumped through the stomach tube. The aim of this study is to investigate the effects of different feeding methods on intestinal function in septic patients.
Interventions
PROCEDUREContinuously feeding
Daily amount of feeding were continuously pumped for 24 hours. EN preparation pumping scheme was as follows: The initial pumping speed was average pumping volume of total enteral nutrition in one day, and gastric residual volumes is checked every 4 hours. If it is not tolerable, the speed of the pumping is reduced by half on the original speed. GRV\<200mL were considered markers of good tolerance.Feeding intolerance was defined as GRV\>200 mL. If GRV\>500mL, EN was stopped and reassessed after 4 hours.
PROCEDURE16-hours feeding
Daily amount of feeding were continuously pumped for 16 hours.EN preparation pumping scheme was as follows: The initial pumping speed was average pumping volume of total enteral nutrition in one day, and gastric residual volumes is checked every 4 hours.If it is not tolerable, the speed of the pumping is reduced by half on the original speed. GRV\<200 mL were considered markers of good tolerance. Feeding intolerance was defined as GRV\>200 mL. If GRV\>500mL, EN was stopped and reassessed after 4 hours.
PROCEDUREintermittent feeding
Daily amount of feeding were divided into four meals, each meal are pumped within 60mins or 120mins through stomach tube. EN preparation pumping scheme was as follows: If the volume of each meal is less than or equal to 250ml(≤250ml), pump in within 60min, if volume is greater than 250ml(\>250ml), pump in within 120min and gastric residual volumes is checked before each intermittent feeding. If it can be tolerated, the velocity of the pumping can be increased by half of the original speed.If it is not tolerable, the speed of the pumping is reduced by half on the original speed. GRV\<200 mL were considered markers of good tolerance. Feeding intolerance was defined as GRV\>200 mL. If GRV\>500mL, EN was stopped and reassessed after 4 hours.
Sponsors
Guangdong Provincial Hospital of Traditional Chinese Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
1. Septic patients in Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine; 2. APACHE-Ⅱ score greater than 15 points; 3. Signing the informed consent.
Exclusion criteria
1. Fasting patients in the clinical, such as digestive tract perforation, bleeding or postoperative patients with gastrointestinal tract; 2. Allergic to enteral nutrition preparations; 3. Don't want to attend the test or not with the healer.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The mean time(hours) that reach to the caloric goal in every group | First 5 days after intervention | Caloric goals using 25 kcal/kg (ideal body weight) for caloric need calculated by a single nutritionist. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The rate of onset of Gastric residual (%) | First 5 days after intervention | The definition of gastric residual is that gastric residual volume more than 500 ml. Comparison of rate of gastric residual among three groups. |
| Abdominal pressure (mmHg) | baseline and 5th day | Abdominal pressure measurement: through the bladder indirect pressure measurement method, first taking the supine position, emptying the bladder urine, secondly pouring 50ml saline into the balloon catheter, to the pubic symphysis as the base point, keeping the piezometric tube be perpendicular to the ground, then abdominal pressure can be obtained indirectly. |
| the rate of new onset pneumonia (%) | First 5 days after intervention | Diagnosis of onset pneumonia is defined as two of the following clinical criteria were required. Fever (\>38.3℃) or hypothermia (≤36.0℃), leukocytosis (\>10×10E9 cells/liter) or leukopenia (≤4×10E9 cells/liter), purulent tracheal aspirate or sputum. The rate of onset pneumonia be counted in each group. |
| The rate(%) of people whom can reaching the caloric goal | First 5 days after intervention | Caloric goals using 25 kcal/kg (ideal body weight) for caloric need calculated by a single nutritionist. |
Other
| Measure | Time frame | Description |
|---|---|---|
| length of ICU stay (in days) | up to 12 weeks | length of ICU stay (in days) |
| ICU mortality rate (%) | 28 days after intervention | ICU mortality rate (%) |
Countries
China
Contacts
Primary ContactGuang Yang
Outcome results
None listed