Improving Nutritional Adequacy of ICU Survivors in a Prospective Interventional Way: the Bright Side Study

Study Overview
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Brief Summary
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The objective is to increase caloric adequacy in patients who survived critical illness and are admitted to the ward by the use of a pro-active inclusive nutritional strategy including supplemental parenteral and/or enteral nutrition and/or oral nutritional supplements guided by indirect calorimetry. This enables the investigators to address, within a clinical/scientific context, a recently demonstrated but until now relatively neglected 'dark side' of patient care at UZ Brussel, comparable to limited global evidence : iatrogenic malnutrition of ICU survivors. The use of a newly developed clinical pathway and nutrition strategy (oral, enteral and parenteral) led by a single SPoC (Single Point of Contact) for patients surviving intensive care will have a clear objective: to address the nutritional deficit in all patients.

Official Title
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Does the Use of Supplemental Parenteral/Enteral Nutrition and/or Oral Nutrition Supplements Guided by Indirect Calorimetry Combined With Standard of Care Increases Energy Feeding Adequacy in Patients Who Survived Critical Illness?

Conditions
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Malnutrition

Intervention / Treatment
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* Other: Clinical Nutrition


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult ≥ 18 years ICU stay ≥ 7 days Ward stay ≥ 3 days Nutritional therapy not restricted Heterogeneous diseases Exclusion Criteria: Patients < 18 years ICU < 7 days Ward stay < 3 days Advanced Care Planning with impact on nutritional therapy Patients with palliative care Metabolic derangements such as metabolic diseases Pregnancy

Ages Eligible for Study
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Minimum Age: 18 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: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Cohort<br>oral food, enteral nutrition, parenteral nutrition | Other: Clinical Nutrition<br>* Nutritional care plan implementation, including A step-up and step-down nutritional protocol guided by caloric and protein ratio Monitoring plan including daily nutritional intake assessment by a dietician and (para)medical supervision by a nutrition support pharmacist and nurse concerning dysphagia, refeeding syndrome, electrolytes abnormalities and access issues Indirect calorimetry measurements to assess metabolic needs and body impedance analysis to assess body composition on regular time points Dedicated and specialized dietician and nurse involvement Adaptive communication policy (translating to native language) and culturally appropriate food regimens and artificial nutrition.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nutrition Adequacy | Increase of caloric adequacy (from 58 to 80%) and protein adequacy (from 52 to 80%) in ICU survivors | The adequacy will be calculated over the entire ward stay: from date of inclusion till 28 days later or death from any cause, whichever came first. |