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Critical IllnessPhase 3TARGETNCT02306746

The Augmented Versus Routine Approach to Giving Energy Trial

A Phase 3 study testing TARGET protocol EN 1.5 kcal/mL and TARGET protocol EN 1.0 kcal/mL in people with Critical Illness, run by Australian and New Zealand Intensive Care Research Centre at 46 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Nutrition therapy is an essential standard of care for all critically ill patients who are mechanically ventilated and remain in the intensive care unit for more than a few days. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Critical Illness
What is being tested?
TARGET protocol EN 1.5 kcal/mL and TARGET protocol EN 1.0 kcal/mL
Could I receive a placebo?
No, everyone receives an active treatment
How many people
4,000 participants
Where
46 sitesin 2 countries
Study dates
16 Jun 2016to 1 Aug 2018
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Intubated and receiving mechanical ventilation
  • About to commence enteral nutrition or enteral nutrition commenced within the previous12 hours
  • Expected to be receiving enteral nutrition in ICU until at least the day after tomorrow

Who cannot join

  • Any Enteral Nutrition (EN) or Parenteral Nutrition (PN) received for >12 hours in this ICU admission
  • Treating clinician considers the EN goal rate (i.e.1ml/kg of ideal body weight per hour) to be clinically contraindicated e.g. requirement for fluid restriction
  • Requirement for specific nutritional therapy as determined by the treating doctor or dietitian i.e. TARGET protocol EN not considered to be in the best interest of the patient
  • Death is deemed to be imminent or inevitable during this admission and either the attending physician, patient or substitute decision maker is not committed to active treatment
  • The patient has an underlying disease that makes survival to 90 days unlikely
  • ≥ 15% burns
  • Previously enrolled in this study

Trial locations and contacts

46 sites in 2 countries.

46 sites in 2 countries

Australia34 sites
  • Royal Adelaide Hosptial

    Adelaide, South Australia, 5000

  • Queen Elizabeth Hospital

    Adelaide, South Australia, 5011

  • Lyell McEwin

    Adelaide, South Australia, 5112

  • Bendigo Hospital

    Bendigo, Victoria, 3550

  • Royal Brisbane and Women's Hospital

    Brisbane, Queensland, 4029

  • Princess Alexandra Hospital

    Brisbane, Queensland, 4102

  • Logan Hospital

    Brisbane, Queensland, 4131

  • Bunbury Hospital

    Bunbury, Western Australia, 6230

  • Canberra Hospital

    Canberra, Australian Capital Territory, 2605

  • Footscray Hospital

    Footscray, Victoria, 3011

  • Frankston Hosptial

    Frankston, Victoria, 3199

  • University Hosptial Geelong

    Geelong, Victoria, 3220

  • Gosford Hospital

    Gosford, New South Wales, 2250

  • Austin Hospital

    Heidelberg, Victoria, 3084

  • Royal Hobart Hospital

    Hobart, Tasmania, 7000

  • Launceston General Hospital

    Launceston, Tasmania, 7250

  • Sunshine Hospital

    Melbourne, Victoria, 3021

  • Royal Melbourne Hospital

    Melbourne, Victoria, 3050

  • St Vincent's Hospital Melbourne

    Melbourne, Victoria, 3065

  • Monash Health Dandenong Hospital

    Melbourne, Victoria, 3175

  • Sir Charles Gairdner Hospital

    Perth, Western Australia, 6009

  • Fiona Stanley Hospital

    Perth, Western Australia, 6150

  • St John of God Hospital Murdoch

    Perth, Western Australia, 6150

  • St Vincent's Hospital Sydney

    Sydney, New South Wales, 2010

  • Royal North Shore Hosptial

    Sydney, New South Wales, 2065

  • Sydney Adventist Hospital

    Sydney, New South Wales, 2076

  • Concord Hospital

    Sydney, New South Wales, 2139

  • Westmead Hospital

    Sydney, New South Wales, 2145

  • Blacktown Hospital

    Sydney, New South Wales, 2148

  • Liverpool Hospital

    Sydney, New South Wales, 2170

  • St George Hospital

    Sydney, New South Wales, 2217

  • Nepean Hospital

    Sydney, New South Wales, 2747

  • Royal Prince Alfred Hospital

    Sydney, New South Wales

  • Toowoomba Hospital

    Toowoomba, Queensland, 4350

Other trials in Australia

New Zealand12 sites
  • North Shore Hospital

    Auckland, 0622

  • Auckland City Hospital Cardiovascular Intensive Care Unit

    Auckland, 1023

  • Auckland City Hospital Department of Critical Care Medicine

    Auckland, 1023

  • Middlemore Hospital

    Auckland, 2025

  • Christchurch Hospital

    Christchurch, 4710

  • Waikato Hospital

    Hamilton, 3204

  • Hawkes Bay Fallen Soldiers Memorial Hospital

    Hastings, 4156

  • Hutt Valley Hospital

    Lower Hutt, 5010

  • Nelson Hospital

    Nelson, 7010

  • Rotorua Hospital

    Rotorua, 3010

  • Tauranga Hospital

    Tauranga, 3112

  • Wellington Regional Hospital

    Wellington, 6021

Other trials in New Zealand

About this study

Official title: The Augmented Versus Routine Approach to Giving Energy Trial: A Randomised Controlled Trial

Nutrition therapy is an essential standard of care for all critically ill patients who are mechanically ventilated and remain in the intensive care unit for more than a few days.

The investigators plan to conduct a 4,000 patient, double-blind, randomised controlled trial to determine if augmentation of calorie delivery using energy dense enteral nutrition in mechanically ventilated patients improves 90 day survival when compared to routine care.

Read the detailed description

Each year around 130,000 Australians are admitted to ICU at a daily cost of approximately $4000 per patient. Their care consumes close to 3 billion dollars per year. These critically ill patients are the sickest in the hospital. They require substantial resources and multiple interventions. Some die and many of those who survive have delayed and compromised functional recovery which can persist for months or years.

Nutrition therapy is an essential standard of care for all ICU patients who are mechanically ventilated and remain in ICU for more than a few days. Enteral nutrition (via a nasogastric tube) is usually initiated within 24 hours of ICU admission with a formula containing 1 kcal/ml and prescribed at an approximate rate of 1 ml/kg/hour. However, standard enteral nutrition practice typically results in the delivery of only ~60% of the full-recommended calorie requirement.

Although prescribed calories can reliably be delivered using the intravenous route, the enteral route is preferred for a number of reasons and is recommended by all nutrition guidelines as first-line therapy. In particular, enteral nutrition is more physiological, less costly and associated with fewer infective complications. Delivery of nutrient into the gut also has beneficial effects on subsequent gut function and may reduce ongoing sepsis which can be fuelled by the movement of gut flora through a permeable mucosa that has not been exposed to nutrient. Intravenous nutrition is accordingly, generally used only when enteral feeding is impossible, or persistently limited. Although supplementing enteral with intravenous nutrition can increase calorie delivery, this has not been shown to have a therapeutic benefit and may worsen important clinical outcomes. This may be because adverse effects associated with intravenous nutrition counteract the benefits of increased calorie delivery.

Previous trials support the concept that optimising nutrition in the critically ill will improve outcome, however, the evidence is limited, inclusive and generally of low quality. It is extraordinary that there is not better (Level I) evidence to inform nutrition management in critically ill patients given the frequency of the intervention, the biologic rationale, the high mortality following ICU admission, the frequency of muscle wasting and the poor functional outcomes in survivors. This is especially true given the low cost of enteral nutrition (~$23/day).

The investigators recently completed pilot study clearly achieved all the key criteria which, for a pharmaceutical product, would lead to a phase III trial, namely: 1. feasibility; 2. safety; 3. separation; 4. excellent recruitment rate; 5. successful blinding; 6. a signal for benefit.

A definitive study must now be done to establish whether 90-day survival and functional outcomes following critical illness may be improved by increased calorie delivery.

Being tested
TARGET protocol EN 1.5 kcal/mL, TARGET protocol EN 1.0 kcal/mL
Keywords
Enteral nutrition, randomised control trial, Critical care, Outcome
Medical subject headings
Critical Illness

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TARGET protocol EN 1.5 kcal/mLDietary supplement

    Enteral feed 1.5 kcal/mL

  • TARGET protocol EN 1.0 kcal/mLDietary supplement

    Enteral feed 1.0 kcal/mL

Study groups in NCT02306746
Study groupRoleWhat they receive
TARGET protocol EN 1.5 kcal/mLExperimentalEnteral (EN) feed 1.5 kcal/mL. The goal rate for administration of TARGET protocol EN is 1ml/kg/hr. To calculate the goal rate, weight is based on ideal body weight.
Receives: Dietary Supplement: TARGET protocol EN 1.5 kcal/mL
TARGET protocol EN 1.0 kcal/mLActive comparatorEnteral feed 1.0 kcal/mL The goal rate for administration of TARGET protocol EN is 1ml/kg/hr. To calculate the goal rate, weight is based on ideal body weight.
Receives: Dietary Supplement: TARGET protocol EN 1.0 kcal/mL

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. All cause mortality

    Mortality status

    Measured: Day 90

Secondary outcomes (18)
  1. Mortality

    Mortality status

    Measured: At hospital discharge an average of 28 days

  2. Mortality

    Mortality status

    Measured: Day 28

  3. Time from randomisation until death

    Mortality status

    Measured: Day 180

  4. Number of days alive and not in ICU

    Mortality status

    Measured: Day 28

  5. Number of days alive and not in hospital

    Mortality status

    Measured: Day 28

  6. Ventilator free days

    Organ support status

    Measured: Day 28

  7. Proportion of patients receiving vasopressor support

    Organ support proportion

    Measured: Day 28

  8. Vasopressor free days

    Organ support status

    Measured: Day 28

  9. Proportion of patients receiving any renal replacement therapy

    Organ support proportion

    Measured: Day 28

  10. Renal replacement therapy free days

    Organ support status

    Measured: Day 28

  11. Proportion of patients with positive blood cultures

    Blood stream infection proportion

    Measured: Day 28

  12. Proportion of patients requiring intravenous antimicrobials

    Patients requiring intravenous antimicrobials

    Measured: Day 28

  13. Mortality

    Mortality status

    Measured: Day 180

  14. Quality of life assessment

    European Quality of Life 5 Dimensions

    Measured: Day 180

  15. Functional outcomes for patients under 65 years in the work force

    Questions from the Australian Labour Force Survey

    Measured: Day 180

  16. Functional outcomes for patients under 65 years and not in the work force and patients 65 years and over living dependently

    World Health Organization Disability Assessment Schedule 2.0

    Measured: Day 180

  17. Functional outcomes for patients 65 years and over living independently

    Adelaide Activities Profile

    Measured: Day 180

  18. Cause-specific mortality

    Mortality status

    Measured: Day 90

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Dec 2014 (estimated)
  2. Study start16 Jun 2016
  3. Primary completion10 Jul 2018
  4. Study completion1 Aug 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
4,000 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02306746
Sponsor's protocol ID
ANZIC-RC/MC001
Acronym
TARGET
Status last verified
Sep 2018
First submitted
11 Nov 2014
Last updated
13 Sep 2018
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Undecided

Publications

  • Peake SL, Lange K, Van Mourik N, Ridley EJ, Williams PJ, Chapman M; TARGET Investigators. The relationship between obesity, calorie delivery and mortality in the critically ill: a post hoc analysis of The Augmented versus Routine Approach to Giving Energy Trial. Am J Clin Nutr. 2026 Mar;123(3):101206. doi: 10.1016/j.ajcnut.2026.101206. Epub 2026 Feb 16.

    PubMed 41781080
  • Wittholz K, Fetterplace K, Chapple LA, Ridley EJ, Finnis M, Presneill J, Chapman M, Peake S, Bellomo R, Karahalios A, Deane AM. Six-month outcomes after traumatic brain injury in the Augmented versus Routine Approach to Giving Energy multicentre, double-blind, randomised controlled Trial (TARGET). Aust Crit Care. 2025 Mar;38(2):101116. doi: 10.1016/j.aucc.2024.09.001. Epub 2024 Oct 10.

    PubMed 39389845
  • Arunachala Murthy T, Chapple LS, Lange K, Marathe CS, Horowitz M, Peake SL, Chapman MJ. Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: Risk factors, natural history, and clinical implications. A post-hoc analysis of The Augmented versus Routine approach to Giving Energy Trial (TARGET). Am J Clin Nutr. 2022 Aug 4;116(2):589-598. doi: 10.1093/ajcn/nqac113.

    PubMed 35472097
  • TARGET Investigators, for the ANZICS Clinical Trials Group; Chapman M, Peake SL, Bellomo R, Davies A, Deane A, Horowitz M, Hurford S, Lange K, Little L, Mackle D, O'Connor S, Presneill J, Ridley E, Williams P, Young P. Energy-Dense versus Routine Enteral Nutrition in the Critically Ill. N Engl J Med. 2018 Nov 8;379(19):1823-1834. doi: 10.1056/NEJMoa1811687. Epub 2018 Oct 22.

    PubMed 30346225

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing TARGET protocol EN 1.5 kcal/mL and TARGET protocol EN 1.0 kcal/mL in people with Critical Illness, run by Australian and New Zealand Intensive Care Research Centre at 46 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Sep 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 46 sites in Australia, New Zealand. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

All cause mortality (time frame: Day 90). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02306746, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Sep 2018.

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