Impact of Early Enteral vs. Parenteral Nutrition on Risk of Gastric-Content Aspiration in Patients Requiring Mechanical Ventilation and Catecholamines

Centre Hospitalier Departemental Vendee139 enrolled

Overview

To evaluate the impact of enteral nutrition on microaspiration of gastric content and pharyngeal secretions

A common obstacle to enteral nutrition is gastrointestinal intolerance, with regurgitations potentially responsible for gastric-content aspiration. Several studies involving technetium 99m (99mTc) labeling of gastric contents have established that gastric-fluid microaspiration is common in critically ill patients receiving both endotracheal ventilation and enteral nutrition. However, to our knowledge, no studies have specifically addressed the role for enteral nutrition in the occurrence of microaspiration. The objective of this ancillary study is to compare the frequency of gastric-content microaspiration in patients given enteral versus parenteral nutrition during the NUTRIREA2 trial. The new knowledge of risk factors for microaspiration provided by this study may help to improve strategies for preventing microaspiration and ventilator-associated pneumonia (VAP).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

139

Conditions

Acute Respiratory Failure Shock

Interventions

Parenteral nutritionOTHER

Enteral nutritionOTHER

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Invasive mechanical ventilation expected to be required more than 48 hours * Nutrition started within 24 hours after initiation of endotracheal mechanical ventilation * Treatment with vasoactive drug administered via a central venous catheter * Age over 18 years * Signed information Exclusion Criteria: * Abdominal surgery within 1 month before inclusion * History of esophageal, gastric, duodenal or pancreatic surgery * Bleeding from the esophagus, stomach or bowel

Locations (6)

CHU Amiens

Amiens, France

Centre hospitalier d'Annecy

Annecy, France

CHU Louis Mourier

Colombes, France

CHU Lille

Lille, France

CHU Saint Louis

Outcomes

Primary Outcomes

proportion of patients with abundant microaspiration (defined as a pepsin level >200 ng/mL in at least 30% of tracheal aspirates)

Every tracheal aspirate will be collected during 48hours following randomisation

Time frame: 48Hours following randomisation

Secondary Outcomes

Salivary amylase levels in tracheal aspirates.

Every tracheal aspirate will be collected during 48hours following randomisation. Salivary amylase will be analysed.

Time frame: 48Hours following randomisation

Data from ClinicalTrials.gov

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