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Critical IllnessPEGNCT04110613

RCT: Early Feeding After PEG Placement

A study testing noFast: Start tube feeds within 1 hour of procedure in people with Critical Illness and Malnutrition, run by Carilion Clinic at 1 site in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Randomized controlled trial to establish evidence on which to base timing of enteral feeding after bedside PEG placement in ventilated Trauma and Surgical ICU patients. Read more about this study

Who is it for?
Ages 18 to 100 years
Conditions the study is for
Critical Illness, Malnutrition, Gastrostomy
What is being tested?
noFast: Start tube feeds within 1 hour of procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,200 participants
Where
1 siteUnited States
Study dates
19 Sep 2019to 30 Sep 2026
Phase
Interventional
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 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult subjects over 18 years of age
  • Negative pregnancy test for women participants of child-bearing age
  • Mechanically ventilated surgical and trauma patients with clinical indication for PEG tube placement
  • Tolerating tube feeds at goal prior to procedure

Who cannot join

  • Patients with aberant gastrointestinal anatomy
  • Patients with gastrointestinal motility disorders
  • Patients with feeding intolerance prior to PEG tube procedure
  • Pregnant women, children, or other vulnerable populations
  • Clinical contraindications for PEG tube placement
  • PEG performed in setting other than ICU at bedside

Trial locations and contacts

1 site in 1 country.

Katie L. Bower, MD contact

540-981-7434

klbower@vt.edu

Jordan Darden, PhD contact

540-529-7792

jadarden@carilionclinic.org

United States1 site, 1 recruiting
  • Carilion Roanoke Memorial Hospital

    Roanoke, Virginia, 24014

    Michelle Rothrock, 540-985-8510, mlrothrock@carilionclinic.org

    Jordan Darden, PhD, 540-529-7792, jadarden@carilionclinic.org

    Recruiting

Other trials in United States

About this study

Official title: A Randomized Controlled Trial to Reduce Periprocedural Fasting in Ventilated Trauma and Surgical Intensive Care Patients

Randomized controlled trial to establish evidence on which to base timing of enteral feeding after bedside PEG placement in ventilated Trauma and Surgical ICU patients.

Read the detailed description

Trauma and surgical intensive care unit(TSICU) patients supported with mechanical ventilation are at high risk for complications associated with malnutrition (Ambrosino and Clini 2004; Aubier et al. 1985; Hill et al. 1998). To mitigate this risk, therapeutic enteral nutrition(EN) is delivered via nasogastric(NGT), orogastric(OGT), or nasoenteric tube(NET) as soon as possible after admission to the intensive care unit(ICU) or upon restoration of gastrointestinal(GI) continuity. Despite these interventions, TSICU patients often suffer a calorie deficit associated with enteral nutrition interruption(ENI) for procedures or transitions in care(Peev et al. 2015; McClave et al. 2009). These periods of fasting predict quantified caloric deficit associated with complications of malnutrition(Peev et al. 2015; Segaran, Barker, and Hartle 2016). Reduction in ENI duration before and after ICU procedures has yielded decreased caloric deficits within mixed ICU populations(Segaran, Barker, and Hartle 2016).

When the need for EN is prolonged, percutaneous endoscopic gastrostomy tube(PEG) placement is a bedside procedure employed to promote progress toward rehabilitation and disposition out of the ICU. First described in 1980, the technique found its success in replacing the classic open gastrostomy performed through a laparotomy incision under general anesthesia(Gauderer, Ponsky, and Izant 1980). Approximately 100,000-125,000 PEGs are performed annually in the United States(Mendiratta et al. 2012). Despite 40 years of experience and its routine nature in modern critical care settings, there is little evidence on which to base timing of tube feeds after PEG placement in the mechanically ventilated Trauma and Surgical ICU(TSICU) population.

Pre- and post-PEG tube placement fasting practices are highly variable among surgical intensivists. There is no standard of care, despite truncated periods of periprocedural fasting described as safe in previously published retrospective and prospective observational studies. There is no evidence to support prolonged fasting after PEG placement in TSICU patients, thus an opportunity to improve patient outcomes by providing evidence that will encourage earlier feeding and a reduction in calorie deficits.The aim of the study is to encourage a standard of care among surgical intensivists that will help to mitigate the risk of malnutrition in this highly susceptible patient population.

Trauma and Surgical ICU patients undergoing bedside PEG tube placement will be randomized to one of two groups: FAST and noFAST. The FAST group will have post-PEG tube feeds initiated 4 hours after the procedure. The noFAST group will have post-PEG tube feeds initiated <1 hour after the procedure. Feeds for both are to be initiated at the rate and with the formula the patient was tolerating prior to the procedure.

Being tested
noFast: Start tube feeds within 1 hour of procedure
Medical subject headings
Critical Illness, Malnutrition, Wounds and Injuries

What participants receive

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

  • noFast: Start tube feeds within 1 hour of procedureDietary supplement

    Earliest possible initiation of tube feeding after bedside PEG tube procedure.

Study groups in NCT04110613
Study groupRoleWhat they receive
noFast: Start tube feeds within 1 hour of procedureActive comparatorThe noFAST group will have post-PEG tube feeds initiated <1 hour after the procedure. Feeds are to be initiated at the rate and with the formula the patient was tolerating prior to the procedure.
Receives: Dietary Supplement: noFast: Start tube feeds within 1 hour of procedure
FAST: Start tube feeds 4 hours after procedureNo interventionThe FAST group will have post-PEG tube feeds initiated 4 hours after the procedure. Feeds are to be initiated at the rate and with the formula the patient was tolerating prior to the procedure.

What is being measured

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

  1. Hours fasted

    Number of hours patients are not receiving prescribed caloric intake

    Measured: 24 hours before to 72 hours after the procedure

Secondary outcomes (2)
  1. Complications

    Complications associated with timing to start tube feeds after bedside PEG placement

    Measured: 0-72 hours after the procedure

  2. Calorie deficit

    Cumulative calorie deficit acquired as a result of peri-procedural fasting

    Measured: 24 hours to 72 hours after procedure

Timeline

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

  1. First posted1 Oct 2019
  2. Study start19 Sep 2019
  3. Primary completion30 Sep 2026 (estimated)
  4. Study completion30 Sep 2026 (estimated)

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 N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Once scheduled for the bedside PEG procedure, patients will be randomized to either the experimental NoFAST group or the control FAST group.
Masking
None (open label)
Enrolment
1,200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04110613
Sponsor's protocol ID
19-355
Acronym
PEG
Status last verified
Oct 2021
First submitted
18 Sep 2019
Last updated
26 Oct 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G; A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):277-316. doi: 10.1177/0148607109335234. No abstract available.

    PubMed 19398613
  • Peev MP, Yeh DD, Quraishi SA, Osler P, Chang Y, Gillis E, Albano CE, Darak S, Velmahos GC. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2015 Jan;39(1):21-7. doi: 10.1177/0148607114526887. Epub 2014 Apr 7.

    PubMed 24714361
  • Segaran E, Barker I, Hartle A. Optimising enteral nutrition in critically ill patients by reducing fasting times. J Intensive Care Soc. 2016 Feb;17(1):38-43. doi: 10.1177/1751143715599410. Epub 2015 Feb 1.

    PubMed 28979456
  • Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980 Dec;15(6):872-5. doi: 10.1016/s0022-3468(80)80296-x.

    PubMed 6780678
  • Ali T, Le V, Sharma T, Vega KJ, Srinivasan N, Tierney WM, Rizvi S. Post-PEG feeding time: a web based national survey amongst gastroenterologists. Dig Liver Dis. 2011 Oct;43(10):768-71. doi: 10.1016/j.dld.2011.04.003. Epub 2011 May 31.

    PubMed 21622036
  • Stein J, Schulte-Bockholt A, Sabin M, Keymling M. A randomized prospective trial of immediate vs. next-day feeding after percutaneous endoscopic gastrostomy in intensive care patients. Intensive Care Med. 2002 Nov;28(11):1656-60. doi: 10.1007/s00134-002-1473-5. Epub 2002 Sep 6.

    PubMed 12415457
  • Gkolfakis P, Arvanitakis M, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, Sanders DS, Schmidt PT, Schneider SM, van Hooft JE. Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021 Feb;53(2):178-195. doi: 10.1055/a-1331-8080. Epub 2020 Dec 21.

    PubMed 33348410
  • Bechtold ML, Matteson ML, Choudhary A, Puli SR, Jiang PP, Roy PK. Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: a meta-analysis. Am J Gastroenterol. 2008 Nov;103(11):2919-24. doi: 10.1111/j.1572-0241.2008.02108.x. Epub 2008 Aug 21.

    PubMed 18721239
  • Cobell WJ, Hinds AM, Nayani R, Akbar S, Lim RG, Theivanayagam S, Matteson-Kome ML, Choudhary A, Puli SR, Bechtold ML. Feeding after percutaneous endoscopic gastrostomy: experience of early versus delayed feeding. South Med J. 2014 May;107(5):308-11. doi: 10.1097/SMJ.0000000000000104.

    PubMed 24937731
  • Szary NM, Arif M, Matteson ML, Choudhary A, Puli SR, Bechtold ML. Enteral feeding within three hours after percutaneous endoscopic gastrostomy placement: a meta-analysis. J Clin Gastroenterol. 2011 Apr;45(4):e34-8. doi: 10.1097/MCG.0b013e3181eeb732.

    PubMed 20733512
  • Vyawahare MA, Shirodkar M, Gharat A, Patil P, Mehta S, Mohandas KM. A comparative observational study of early versus delayed feeding after percutaneous endoscopic gastrostomy. Indian J Gastroenterol. 2013 Nov;32(6):366-8. doi: 10.1007/s12664-013-0348-8. Epub 2013 Aug 17.

    PubMed 23949988
  • Dubagunta S, Still CD, Kumar A, Makhdoom Z, Inverso NA, Bross RJ, Komar MJ, Mulhisen L, Rogers JZ, Whitmire S, Whilden B. Early initiation of enteral feeding after percutaneous endoscopic gastrostomy tube placement. Nutr Clin Pract. 2002 Apr;17(2):123-5. doi: 10.1177/0115426502017002123.

    PubMed 16214975
  • Schneider AS, Schettler A, Markowski A, Luettig B, Kaufmann B, Klamt S, Lenzen H, Momma M, Seipt C, Lankisch T, Negm AA; *Conference presentation: 36th ESPEN Congress in Leipzig, Germany on August 31st - September 3rd, 2013. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol. 2014 Jul;49(7):891-8. doi: 10.3109/00365521.2014.916343. Epub 2014 Jun 4.

    PubMed 24896841
  • Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML, Kinn TJ, Klang MG, Lord L, Martin K, Pompeii-Wolfe C, Sullivan J, Wood A, Malone A, Guenter P; ASPEN Safe Practices for Enteral Nutrition Therapy Task Force, American Society for Parenteral and Enteral Nutrition. ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text]. JPEN J Parenter Enteral Nutr. 2017 Jan;41(1):15-103. doi: 10.1177/0148607116673053. Epub 2016 Nov 5.

    PubMed 27815525
  • Blaser AR, Starkopf J, Kirsimagi U, Deane AM. Definition, prevalence, and outcome of feeding intolerance in intensive care: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2014 Sep;58(8):914-22. doi: 10.1111/aas.12302. Epub 2014 Mar 11.

    PubMed 24611520

Questions about this trial

What is this clinical trial studying?

A study testing noFast: Start tube feeds within 1 hour of procedure in people with Critical Illness and Malnutrition, run by Carilion Clinic at 1 site in United States.

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 4 inclusion and 6 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: status not confirmed, as of the sponsor's last update on 26 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. 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.

Are results available for this study?

Results are not available in the source record.

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

Contact Katie L. Bower, MD (540-981-7434, klbower@vt.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Hours fasted (time frame: 24 hours before to 72 hours after the procedure). 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 NCT04110613, which also lists 20 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 26 Oct 2021.

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