The Impact of IC-Guided Feeding Protocol on Clinical Outcomes in Critically Ill Patients (The IC-Study)

Study Overview
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Brief Summary
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Adequate nutritional support is an essential element for achieving favourable outcomes in critically ill patients. Therefore, an accurate determination of patients' energy needs is required to optimize nutritional support and reduce the harmful effects of under- and over-feeding. Currently, indirect calorimetry is considered as a gold standard for measuring energy expenditure during critical illness. This randomized study aims to investigate the impact of indirect calorimetry guided nutrition therapy on clinical outcomes such as ICU. Mortality, hospital mortality, duration of mechanical ventilation, length of I.C.U./hospital stay and mascle wasting. The investigators hypothesis that nutrition therapy guided by IC will improve clinical outcomes in severely ill patients

Detailed Description
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This is a single-blind randomized control study. Eligible participants are randomly assigned within 24 hrs of ICU. admission in two groups Intervention group: The calorie needs will be determined by indirect calorimetry. Control group: a routine standard weight-based equation (20-25kcal/kg ideal body weight/day) will be used to estimate the energy requirements of critically ill patients. Daily energy and protein data will be recorded for a maximum of 12 evaluable days (nutritional days) or until death or discharge from ICU.while outcome data will be collected for a maximum of 28 days.

Official Title
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The Impact of Indirect Calorimetry Guided Medical Feeding Protocol on Clinical Outcomes in Critically Ill Patients

Conditions
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Critical Illness

Intervention / Treatment
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* Dietary Supplement: Enteral Nutrients ( Nutren Optimum, Nutren Diabetes, Novasource Renal ), Parenteral Nutrient ( Smofkabiven)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients aged over 18 years old Critically ill patients with me ical ventilation Expected to have an ICU. stay of more than (3) days Exclusion Criteria: Requirement for inspired oxygen content (FiO2) greater than 0.6 Patients on high-frequency ventilation Patients with chest tubes that leak air/ Bronchopleural fistula Patients with incompetent tracheal cuff Patients inhaled nitric oxide therapy Patients receiving continuous renal replacement therapy (CRRT) during IC measurement Patients with pregnancy Patients with burn injury Patients infected with human immunodeficiency virus (HIV) Patients with severe liver disease (Child-Pugh score C) seizure activity patients suffering from significant head trauma (GCS <8) Patients with paraplegia and quadriplegia

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Indirect Calorimetry- Directed Nutrition<br>Enteral Nutrition (EN) will be the preferred route of nutrition, and will be initiated within the first 24-48 hours of ICU admission. Caloric requirements will be measured by indirect calorimetry IC as soon as possible after recruitment and will be repeated in every 24 hrs. The amount of delivery is gradually increased to avoid the possibility of gastrointestinal intolerance. If EN fails to reach caloric goals or not feasible supplementary Parenteral nutrition(PN) will be initiated after 5-7days | Dietary Supplement: Enteral Nutrients ( Nutren Optimum, Nutren Diabetes, Novasource Renal ), Parenteral Nutrient ( Smofkabiven)<br>* Enteral nutrition feeding formula is used in powder form and will be reconstituted by attending nurses, Continuous feeding is commonly used which will be prescribed by the attending clinicians, Energy and protein intake from EN will be estimated by multiplying the volume of feed given to energy (kcal) and protein (g) in 1 ml of standard dilution, and for Standard PN product, energy and protein intake will also be calculated based on the volume infused.<br>|
| Active Comparator: Standard weight-based equation- Directed Nutrition<br>Enteral Nutrition (EN) will be initiated within the first 24-48 hours of ICU. Admission. Enteral nutrient delivery is gradually increased to avoid the possibility of gastrointestinal intolerance so that a few days are required to achieve the caloric target. PN will be started after 5-7 days if EN is not feasible. Energy and protein goals will be calculated by the standard weight-based equation of 25 kcal/kg BW body weight and 1.2-2.5 g/kg body weight, respectively. | Dietary Supplement: Enteral Nutrients ( Nutren Optimum, Nutren Diabetes, Novasource Renal ), Parenteral Nutrient ( Smofkabiven)<br>* Enteral nutrition feeding formula is used in powder form and will be reconstituted by attending nurses, Continuous feeding is commonly used which will be prescribed by the attending clinicians, Energy and protein intake from EN will be estimated by multiplying the volume of feed given to energy (kcal) and protein (g) in 1 ml of standard dilution, and for Standard PN product, energy and protein intake will also be calculated based on the volume infused.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ICU mortality | Rate of mortality from all causes before or at day 28 in the ICU during the same ICU admission | 28 Days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of ICU stay | will be measured as the number of calendar days between admission and discharge from ICU.or until 28 days | 28 Days | 
| Length of mechanical ventilation | will be measured as the calendar days between start and end of mechanical ventilation until 28 days | 28Days | 
| Length hospital stay | will be calculated using the admission date and expiration or discharge date from hospital until 28 days | 28 Days | 
| Hospital mortality | Rate of mortality from all causes (death in ICU or in ward) before or at day 28 during the same hospital admission. | 28Days | 
| Muscle wasting | define as differences between the serial ultrasound measurement of quadriceps femoris muscle layer thickness (vastus intermedius and rectus femoris) over the first 10 days(on day 1,3,5,7 and 10 ) of ICU Admission. | First 10 days of ICU admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Indirect calorimetry, Energy expenditure, Critical illness