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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03292237
Registration number
NCT03292237
Ethics application status
Date submitted
11/09/2017
Date registered
25/09/2017
Titles & IDs
Public title
Intensive Nutrition in Critically Ill Adults
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Scientific title
Intensive Nutrition Therapy Compared to Usual Care in Critically Ill Adults: A Randomised Pilot Trial
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Secondary ID [1]
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ANZIC-RC/ER001
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Universal Trial Number (UTN)
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Trial acronym
INTENT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Critical Illness
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Critically Ill
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Condition category
Condition code
Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Other - Supplemental parenteral nutrition
No intervention: Standard Nutrition Arm - In ICU:
1. After enrolment, patients allocated to the standard nutrition therapy (control) group will commence or continue nutrition via an enteral tube to a target rate according to unit protocol including the use of promotility agents and the placement of nasojejunal feeding tubes if required.
2. PN will only be used if the above methods have been attempted, or an absolute contraindication to EN develops.
3. Unless there is specific indication for a compounded PN solution, the PN used in the standard care group will be the same as used in the intervention arm.
After ICU:
1. Nutrition management will be as per usual site management at that hospital.
2. Nutrition intake amounts will be recorded 3 times per week using provided study documents and assessment tools.
Experimental: Intensive Arm - Intervention
In ICU:
1. Supplemental PN will be commenced within 2 hours of randomisation. The starting dose of PN will be determined by the amount of energy received in the 24 hours prior to randomisation
2. The need for the intervention will be based on the adequacy of nutrition provision from both PN and EN and assessed daily until ICU discharge
3. If there is an actual or anticipated interruption of EN for greater than 2 hours the PN must be run at 20 kcal/kg calculated body weight until EN is recommenced. After the interruption, EN should be recommenced as per local protocol.
After ICU:
An intensive nutrition intervention will be provided on the ward in the intervention group. This will include daily review from dedicated study dietitians and a clearly protocolized hierarchical management plan which reflects best practice clinical management.
Treatment: Other: Supplemental parenteral nutrition
Supplemental parenteral nutrition OLIMEL N12E (Baxter Healthcare Corporation)
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Intervention code [1]
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Treatment: Other
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Daily energy delivered from nutrition therapy
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Assessment method [1]
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Daily energy delivered from nutrition therapy
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Timepoint [1]
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Day 28
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Secondary outcome [1]
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Nutrition intake
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Assessment method [1]
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Daily protein intake, Energy and protein intake by location (ICU and ward)
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Timepoint [1]
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Day 28
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Secondary outcome [2]
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Duration hospital stay
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Assessment method [2]
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Duration of hospital stay in survivors and non-survivors
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Timepoint [2]
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Day 28
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Secondary outcome [3]
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Ventilator Free Days
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Assessment method [3]
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Ventilator Free Days (VFDs) at study day 28
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Timepoint [3]
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Day 28
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Secondary outcome [4]
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Total blood stream infection rate
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Assessment method [4]
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Total blood stream infection rate
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Timepoint [4]
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Day 28
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Eligibility
Key inclusion criteria
Inclusion criteria
Patients in intensive care who meet all of the following will be eligible:
1. Admitted to intensive care between 72 hours and 120 hours
2. Receiving invasive ventilator support
3. At least 18 years of age
4. Have central venous access suitable for PN solution administration
5. Have 1 or more organ system failure (respiratory, cardiovascular or renal) related to their acute illness defined as:
* PaO2/FiO2 = 300 mmHg
* Currently on 1 or more continuous inotrope/vasopressor infusion which were started at least 4 hours ago at a minimum dose of:
1. Noradrenaline = 0.1mcg/kg/min
2. Adrenaline = 0.1 mcg/kg/min
3. Any dose of vasopressin
4. Milrinone > 0.1 mcg/kg/min
* Renal dysfunction defined as:
1. Serum creatinine 2.0-2.9 times baseline OR
2. Urine output 0.5ml/kg/hr for = 12 hours OR
3. Currently receiving renal replacement therapy
* Currently has an intracranial pressure monitor or ventricular drain in situ
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion criteria
Patients will be excluded if:
* Both EN and PN cannot be delivered at enrolment (i.e. either an enteral tube or a central venous catheter cannot be placed or clinicians feel that EN or PN cannot be safely administered due to any other reason)
* Currently receiving PN
* Clinician believes a specific parenteral formula is indicated
* Death is imminent in the next 96 hours
* There is a current treatment limitation in place or the patient is unlikely to survive to 6 months due to underlying/chronic illness
* More than 80% of energy requirements have been satisfactorily delivered via the enteral route in the last 24 hours
* Dialysis dependent chronic renal failure
* Suspected or known pregnancy
* Product contraindication
* The treating clinician does not believe the study to be in the best interest of the patient
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Study design
Purpose of the study
Other
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
15/10/2018
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
31/07/2023
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Sample size
Target
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Accrual to date
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Final
240
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Recruitment in Australia
Recruitment state(s)
NSW,NT,QLD,SA,VIC
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Recruitment hospital [1]
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Blacktown Hospital - Blacktown
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Nepean Hospital - Kingswood
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Royal Darwin Hospital - Darwin
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Prince Charles Hospital - Brisbane
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Redcliffe Hospital - Redcliffe
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Mater Hospital - South Brisbane
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Gold Coast University Hospital - Southport
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Princess Alexandra Hospital - Woolloongabba
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Lyell McEwin - Elizabeth Vale
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Queen Elizabeth Hospital - Woodville South
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Ballarat Hospital - Ballarat
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Bendigo Hospital - Bendigo
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Northern Hospital - Epping
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Frankston Hospital - Peninsula Health - Frankston
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Geelong Hospital - Geelong
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Austin Hospital - Heidelberg
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The Alfred Hospital - Melbourne
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Royal Melbourne Hospital - Melbourne
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Recruitment hospital [19]
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Epworth Richmond - Melbourne
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Recruitment hospital [20]
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Box Hill Hospital - Melbourne
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Recruitment hospital [21]
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Monash Medical Centre - Melbourne
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Recruitment postcode(s) [1]
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2148 - Blacktown
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Recruitment postcode(s) [2]
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2747 - Kingswood
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Recruitment postcode(s) [3]
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0810 - Darwin
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Recruitment postcode(s) [4]
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4032 - Brisbane
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Recruitment postcode(s) [5]
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4020 - Redcliffe
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Recruitment postcode(s) [6]
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4101 - South Brisbane
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Recruitment postcode(s) [7]
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4215 - Southport
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Recruitment postcode(s) [8]
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4102 - Woolloongabba
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Recruitment postcode(s) [9]
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5112 - Elizabeth Vale
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Recruitment postcode(s) [10]
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5011 - Woodville South
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Recruitment postcode(s) [11]
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3350 - Ballarat
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Recruitment postcode(s) [12]
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3550 - Bendigo
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Recruitment postcode(s) [13]
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3076 - Epping
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Recruitment postcode(s) [14]
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3199 - Frankston
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Recruitment postcode(s) [15]
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3220 - Geelong
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Recruitment postcode(s) [16]
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3084 - Heidelberg
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Recruitment postcode(s) [17]
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3004 - Melbourne
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Recruitment postcode(s) [18]
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3010 - Melbourne
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Recruitment postcode(s) [19]
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3121 - Melbourne
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Recruitment postcode(s) [20]
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3128 - Melbourne
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Recruitment postcode(s) [21]
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3168 - Melbourne
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Auckland
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Funding & Sponsors
Primary sponsor type
Other
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Name
Australian and New Zealand Intensive Care Research Centre
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Address
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Country
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Other collaborator category [1]
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Commercial sector/industry
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Name [1]
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Baxter Healthcare Corporation
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
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Summary
Brief summary
Despite the widespread use of nutrition therapy, no large scale randomized controlled trials (RCTs) have demonstrated positive outcomes with delivery of nutrition therapy early in critical illness, with some showing no effect with delayed nutrition or even harm. There are several possible reasons for the lack of observed benefit from RCTs to date; interventions have been short in duration (usually 3-10 days after intensive care unit (ICU) admission), perhaps applied at the incorrect time in regards to the patients metabolism and recovery, do not consider the patients nutrition risk, and have not addressed what happens to nutrition intake post ICU in critically ill individuals. This may explain why RCTs to date have not observed any positive associations with the delivery of nutrition; our focus to date may have been on the wrong stage of illness. A future study is thus urgently needed, which addresses the deficiencies in current RCTs by optimizing nutrition delivery for the whole hospital stay and collecting meaningful clinical, process and outcome data, which will potentially inform a larger trial of a similar nature. This initial study aims to determine whether optimization of energy using a pre-tested supplemental parenteral nutrition (PN) strategy in the Intensive Care Unit (ICU) and an intensive nutrition intervention in the post ICU period will deliver more total energy than standard nutrition care during hospital admission in a group of critically ill patients with at least one organ system failure.
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Trial website
https://clinicaltrials.gov/study/NCT03292237
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Trial related presentations / publications
Ridley EJ, Bailey M, Chapman M, Chapple LS, Deane AM, Hodgson C, King VL, Marshall A, Miller EG, McGuinness SP, Parke R, Udy AA; the Australian and New Zealand Intensive Care Society Clinical Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group. Protocol summary and statistical analysis plan for Intensive Nutrition Therapy comparEd to usual care iN criTically ill adults (INTENT): a phase II randomised controlled trial. BMJ Open. 2022 Mar 8;12(3):e050153. doi: 10.1136/bmjopen-2021-050153. Ridley EJ. Parenteral nutrition in critical illness: total, supplemental or never? Curr Opin Clin Nutr Metab Care. 2021 Mar 1;24(2):176-182. doi: 10.1097/MCO.0000000000000719. Ridley EJ, Parke RL, Davies AR, Bailey M, Hodgson C, Deane AM, McGuinness S, Cooper DJ. What Happens to Nutrition Intake in the Post-Intensive Care Unit Hospitalization Period? An Observational Cohort Study in Critically Ill Adults. JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):88-95. doi: 10.1002/jpen.1196. Epub 2018 Jun 20.
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Public notes
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Contacts
Principal investigator
Name
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Emma Ridley, PhD
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Address
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ANZIC-RC
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Fax
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Email
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Contact person for public queries
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Data sharing requests will be considered 2 years after publication of the primary trial data on an individual basis by the trial management committee (the data custodians). Data sharing will only be considered for investigator-initiated, independent researchers who provide a written data evaluation proposal that is judged to be methodologically sound. A data sharing agreement will be required to detail conditions under which data is shared and used. Resulting publications should appropriately cite and acknowledge the original data custodians. Requests for data sharing are to be made to
[email protected]
and the corresponding author, Dr Emma Ridley;
[email protected]
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When will data be available (start and end dates)?
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Available to whom?
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03292237