ARDS (Moderate or Severe), Enteral Nutrition Feeding, Intensive Care Unit (ICU) Admission, Prone Position
Conditions
Keywords
ARDS, Mechanical ventilation, Prone position, Enteral nutrition, Gastric retention, Clinical outcome
Brief summary
During the prone position, there may be an increase in intragastric pressure. The investigators focus on a scientific question: Whether reducing enteral nutrition before the prone position will benefit patients with severe mechanically ventilated acute respiratory distress syndrome (ARDS). The experimental group had the enteral nutrition dose reduced before the prone position, while the control group did not have the enteral nutrition dose reduced
Detailed description
During the prone position, there may be an increase in intragastric pressure. The investigators focus on a scientific question: Whether reducing enteral nutrition before the prone position will benefit patients with severe mechanically ventilated ARDS. The experimental group had the enteral nutrition dose reduced before the prone position, while the control group did not have the enteral nutrition dose reduced
Interventions
PROCEDUREEnteral nutrition is reduced before the prone position
Before the prone position, the gastric contents are aspirated with a syringe, and the dose of enteral nutrition reduction is determined based on the different amounts of gastric residue. If the residual volume in the stomach is less than 200ml, the enteral nutrition intake will be reduced by one third. Gastric residual volume 200-500ml: Reduce enteral nutrition by half. If the residual gastric volume is greater than 500ml: Stop enteral nutrition and consider post-pyloric feeding
Sponsors
The First Hospital of Jilin University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years old * Within 24 hours of admission to the ICU, one or more organ systems have failed (the Sequential Organ Failure Assessment (SOFA) score of any single organ system is ≥2) * Meet the diagnostic criteria for moderate/severe ARDS (even after optimizing the ventilation Settings, the oxygenation index is still \< 150mmHg and PEEP is still ≥5 cm H2O) * It is expected to stay in the ICU for more than 48 hours
Exclusion criteria
* There are contraindications for the prone position * There are contraindications for EN, preventing the initiation of early EN (≤48 hours) * Expected to die within 48 hours * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of gastric retention during prone position | Acute stage of critical illness (within 7 days of Intensive Care Unit (ICU)) | The incidence of gastric retention (with a single gastric residual volume \> 200ml) during prone position. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The frequency of gastric retention during the prone position | Acute stage of critical illness (within 7 days of ICU) | The number of times of gastric retention (with a single gastric residual volume \> 200ml) per unit time during prone position (times per day) |
| The incidence of diarrhea during ICU stay | Acute stage of critical illness (within 7 days of ICU) | Having three or more loose or liquid stools per day, with a stool weight greater than 200-250g/d (or more than 250ml/d) |
| The incidence of Ventilator-associated pneumonia (VAP) among the participants | During the length of stay in the ICU (from day 1 to a maximum of 28 days) | Pulmonary infectious inflammation that occurs 48 hours after the end of ventilator treatment is a type of hospital-acquired pneumonia |
| Nutrition compliance rate | The seventh day in the ICU | Whether the patient reached 80% of the nutritional (calories: 25kcal/kg/day and protein :1.3g/kcal) target on the 7th day of hospitalization in the ICU |
| Gastric antral cross-sectional area (ACSA) measured by ultrasound after the end of prone positioning | After each prone position during the ICU stay | The ultrasound cross-sectional area of the antrum of the stomach after adjusting to the normal position at the end of the prone position |
| Length of stay in the ICU | During the length of stay in the ICU (from day 1 to a maximum of 180 days) | The number of days spent in the ICU |
| ICU mortality | During the length of stay in the ICU (from day 1 to a maximum of 180 days) | Whether there was death during the ICU stay |
| 28-day mortality | Day 28 after being admitted to the ICU | Whether the patient died on the 28th day after being admitted to the ICU |
| 90-day mortality | The 90th day after being admitted to the ICU | Whether the patient died on the 90th and 180th days after being admitted to the ICU |
| 180-day mortality | Day 180 after being admitted to the ICU | Whether the patient died on the 180th day after being admitted to the ICU |
| EN interruption rate | Acute stage of critical illness (within 7 days of ICU) | High gastric residual volume (single dose \> 500ml) or serious gastrointestinal adverse events lead to the need to suspend EN administration |
| The incidence of gastric retention during ICU stay | Within 1 to 7 days of hospitalization in the ICU | The incidence of gastric retention within 7 days of ICU hospitalization (The single gastric residual volume is greater than 200ml) |
Countries
China
Contacts
CONTACTYouquan Wang, M.D.
Outcome results
None listed