Impact of Supplemental Parenteral Nutrition in ICU Patients on Metabolic, Inflammatory and Immune Responses (SPN2)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02022813
Recruitment Status : Completed
First Posted : December 30, 2013
Last Update Posted : February 19, 2018
University of Geneva, Switzerland
Information provided by (Responsible Party):
Mette M Berger, Centre Hospitalier Universitaire Vaudois

Brief Summary:
Having previously demonstrated that supplemental parenteral nutrition to complete an insufficient enteral nutrition (EN) between D4 and D8 improves outcome after critical illness, by reducing infectious complications, the present trial aims at investigating the underlying carbohydrate and protein metabolism changes, as well as the immune and inflammatory modulations associated with this improvement.

Condition or disease Intervention/treatment Phase
Critical Illness Dietary Supplement: Supplemental parenteral nutrition (SPN) Not Applicable

Detailed Description:

Enrollment on day 3 of critically ill patients, without contraindication to EN, not achieving 60% of the ICU per protocol energy target.

Intervention: Randomization to either continued pure EN, or from day 4 to supplemental PN to complete EN at target validated by indirect calorimetry.

Measurements: Indirect calorimetry on Days 3, 4, 9 (twice). Primary endpoints = glucose and leucine metabolism On days 4 and 9-10: isotopic investigation of glucose metabolism, and immune and inflammatory responses// Day 9-10: isotopic investigation of protein (leucine) metabolism Secondary endpoints: Insulin requirements, area under the curve (AUC) of blood Glucose, infections after day 9, overall complications, length of mechanical ventilation, of ICU and hospital stay.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 28 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Supportive Care
Official Title: Impact of Supplemental Parenteral Nutrition (SPN) on Energy Balance, and Infection Rate in Intensive Care Patients: Underlying Metabolic, Inflammatory and Immune Mechanisms.
Actual Study Start Date : April 2014
Actual Primary Completion Date : September 2016
Actual Study Completion Date : June 2017

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
No Intervention: Enteral nutrition only
Enteral nutrition to be progressed as soon as possible to energy target measured on day 3, and verified on day 4, using the usual facilitators (prokinetics)
Experimental: Supplemental parenteral nutrition

Addition of supplemental parenteral nutrition to complete the gap between energy delivered by enteral feeding and energy target measured on day 4.

Aim: 100% of this target, and not exceeding it, no catch up for energy deficit accumulated before day 4.

Dietary Supplement: Supplemental parenteral nutrition (SPN)
The amount of energy delivered by SPN will depend on the indirect calorimetry measurement and actual enteral feed delivery. SPN will be reduced with progressing EN
Other Name: Standard industrial PN solutions

Primary Outcome Measures :
  1. Glucose and Leucine turnover [ Time Frame: 10 days ]
    On D04:Infusion after priming of 6.6 2H2 glucose and NaH13CO3 On Day 09-10: Infusion after priming of NaH13CO3 and of L-[1-13C]-Leucine + repeat of the glucose sequence

Secondary Outcome Measures :
  1. Immune and inflammatory impact of optimized target feeding [ Time Frame: 10 days ]

    lymphocyte phenotypes: lymphocyte subpopulations (frequency), level of activation (CD69), memory markers, effectors, regulators

    • Cluster differentiation CD4, CD8, and natural killer (NK) phenotypes
    • Cell inflammatory response (WBA and PBMC) on D4 and D10±1: IL-2, TNF-α, interleukine-6 (IL-6), IL-1, TGF, IL-10, in culture for 24 to 48h ex vivo and post stimulation by memory mix and mitogens.
    • Serological inflammatory response (WBA and PBMC) on D4 and D10+1: TNF-α , IL-6, C-reactive protein (CRP): ex vivo with ELISA Nosocomial infections after day 8

Other Outcome Measures:
  1. Global outcome [ Time Frame: 28 days / 90 days ]
    Overall complications and organ failures, length of mechanical ventilation, length of ICU and hospital stay.

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Ages Eligible for Study:   16 Years to 90 Years   (Child, Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • estimated duration of ICU stay > 5 days,
  • estimated survival > 7 days,
  • absence of contraindication to EN
  • need for mechanical ventilation
  • informed consent obtained from patients, close relative, or referring physician

Exclusion Criteria:

  • refusal of the patient or of the next of kin
  • age < 18 years
  • non-functional digestive tract (short bowel, persistent ileus, proximal intestinal fistula high rate > 1.5 litres/day)
  • already receiving PN before Day 3
  • absence of a central venous catheter
  • women who are pregnant (pregnancy test).
  • Admission after cardiac arrest, or severe brain injury

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02022813

Nutrition Unit, Geneva University Hospital
Geneva, GE, Switzerland, 1211
Service of Adult Intensive Care - CHUV
Lausanne, VD, Switzerland, 1011
Sponsors and Collaborators
Centre Hospitalier Universitaire Vaudois
University of Geneva, Switzerland
Principal Investigator: Mette M Berger, MD PhD CHUV, Lausanne

Responsible Party: Mette M Berger, Prof, Centre Hospitalier Universitaire Vaudois Identifier: NCT02022813     History of Changes
Other Study ID Numbers: CE 371-13
First Posted: December 30, 2013    Key Record Dates
Last Update Posted: February 19, 2018
Last Verified: February 2016

Keywords provided by Mette M Berger, Centre Hospitalier Universitaire Vaudois:
Energy requirements, Glucose turnover, Protein turnover

Additional relevant MeSH terms:
Critical Illness
Disease Attributes
Pathologic Processes