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| Name | Class |
|---|---|
| Tang-Du Hospital | OTHER |
| Xi'an Central Hospital | OTHER |
| Xi'an Gaoxin Hospital | OTHER |
| First Affiliated Hospital Xi'an Jiaotong University |
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Post stroke pneumonia (PSP) is one of the common early complications of stroke. Post-stroke infections, in general, are associated with less favorable neurologic outcomes. Aspiration is one of the most feared complications of enteral nutrition and can lead to the occurrence of pneumonia. Severe stroke patients are at high risk for aspiration due to some factors such as the reduced level of consciousness, inability to protect the airway and so on. The purpose of this study is to explore the ideal nutrition support strategy for patient with acute severe stroke to help reduce the incidence of PSP and improve the prognosis.
As one of the most common complication of stroke, some studies showed that post-stroke pneumonia (PSP) in stroke patients requiring intensive care is associated with an increase of ICU length of stay and hospital mortality and poorer functional outcomes in survivors. The peak period of PSP is within the first week after stroke. Aspiration and poor nutritional status are important factors leading to pneumonia in stroke patients. Compared with full enteral nutrition (EN), initial trophic enteral feeding was associated with less gastrointestinal intolerance and could reduce the rate of regurgitation. However, trophic enteral feeding could not meet the daily caloric needs and hypocaloric enteral nutrition might be associated with increased mortality. This study is designed to explore whether initial trophic enteral nutrition combined with supplemental parenteral nutrition (SPN) can help reduce the incidence of PSP and improve the prognosis in severe patients with stroke.
This study will enroll 546 severe stroke patients who meet the inclusion criteria. Upon admission to the ICU, patients will be randomly assigned at a 1:1 ratio into groups of full enteral feeding (controlled) and trophic enteral feeding combined with supplemental parenteral feeding (experimented) for 7 days.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Full enteral feeding | Active Comparator | Patients will receive full enteral feeding through nasogastric tube or nasointestinal tube. |
|
| Trophic enteral feeding combined with supplemental parenteral nutrition | Experimental | Patients will receive trophic enteral feeding combined with supplemental parenteral feeding. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Trophic enteral feeding combined with supplemental parenteral nutrition | Procedure | The caloric goal of the first day is one-third of caloric requirements, the second day is half of caloric requirements, the third day is 70-100% and sustained for 1 week. Patients will receive the trophic enteral feeding with a caloric target of 500kcal/d (20-35ml/h), and the remaining calories are supplemented by parenteral nutrition. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of post stroke pneumonia | up to 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| The time from randomisation to the onset of the post stroke pneumonia | up to 7 days | |
| Daily calorie delivery | up to 7 days | |
| Daily protein delivery |
| Measure | Description | Time Frame |
|---|---|---|
| Composite endpoint of all-cause mortality and post-stroke pneumonia | Hierarchical composite endpoint of all-cause mortality and post-stroke pneumonia within 90 days | 90 days after randomization |
| Composite endpoint of all-cause mortality and post-stroke pneumonia |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Chongqing University Three Gorges Hospital | Chongqing | Chongqing Municipality | 404100 | China | ||
| Daping Hospital, The Third Military Medical University |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26343837 | Background | Meisel A, Smith CJ. Prevention of stroke-associated pneumonia: where next? Lancet. 2015 Nov 7;386(10006):1802-4. doi: 10.1016/S0140-6736(15)00127-0. Epub 2015 Sep 3. No abstract available. | |
| 22225864 | Background | Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis. 2012 Jan;21(1):61-7. doi: 10.1016/j.jstrokecerebrovasdis.2010.05.002. Epub 2010 Jun 17. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol: Final Protocol | Sep 22, 2023 |
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| OTHER |
| Xi'an No.3 Hospital | OTHER_GOV |
| First People's Hospital of Xianyang | OTHER |
| Nanfang Hospital, Southern Medical University | OTHER |
| Tongji Hospital | OTHER |
| Qilu Hospital of Shandong University | OTHER |
| The Second Hospital of Shandong University | OTHER |
| PLA 960 Hospital | UNKNOWN |
| Daping Hospital of Army Medical University | OTHER |
| The Second Affiliated Hospital of Guangzhou University of Chinese Medicine | UNKNOWN |
| First Hospital Affiliated to Zhengzhou University | UNKNOWN |
| Gansu Provincial Central Hospital | UNKNOWN |
| The First Hospital of Changsha City | UNKNOWN |
| Shaanxi Provincial People's Hospital | OTHER |
| Yulin No.2 Hospital | OTHER |
| Yulin No.1 Hospital | UNKNOWN |
| Xijing Hospital | OTHER |
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|
| Full enteral feeding | Procedure | The caloric goal of the first day is one-third of caloric requirements, the second day is half of caloric requirements, the third day is 70-100% and sustained for 1 week. Protein requirements are calculated at 1.2 to 1.5 g per kilogram of body weight per day. Enteral nutrition is given through nasogastric tube or nasointestinal tube. |
|
| up to 7 days |
| Insulin utilization | Insulin utilization during the first 7 days post-randomization | up to 7 days |
| The incidence of gastrointestinal complications | Vomiting, diarrhea, gastric retention, gastrointestinal bleeding | up to 7 days |
| The use of prokinetic agents | The usage rate of prokinetic agents | up to 7 days |
| The occurrence of infections | The rate and onset time of infections from randomisation to ICU discharge | 1 day of ICU discharge |
| The length of ICU stay | 1 day of ICU discharge |
| Mortality | from randomisation to all cause death during ICU stay. | 1 day of ICU discharge |
| The All-cause mortality rate | from randomisation to all cause death at 28 days | 28 days after enrollment |
| Cardiac failure | The incidence of cardiac failure from randomisation to ICU discharge | 1 day of ICU discharge |
| Tracheotomy | The incidence of tracheotomy from randomisation to ICU discharge | 1 day of ICU discharge |
| Mechanical ventilation | The incidence of mechanical ventilation from randomisation to ICU discharge | 1 day of ICU discharge |
| Continuous renal replacement therapy | The incidence of continuous renal replacement therapy from randomisation to ICU discharge | 1 day of ICU discharge |
| The use of vasoactive agents | The usage rate of vasoactive agents from randomisation to ICU discharge | 1 day of ICU discharge |
| Deep venous thrombosis | The incidence of deep venous thrombosis from randomisation to ICU discharge | 1 day of ICU discharge |
| The score of National Institute of Health stroke scale at ICU discharge | National Institute of Health stroke scale, with scores ranging from 0 (normal function) to 42 (functional impairment) was used to evaluate the impairment caused by a stroke. | 1 day of ICU discharge |
| Glasgow Coma Scale at ICU discharge | Glasgow Coma Scale,with scores ranging from 3 (no response) to 15 (normal response), was used to grade the conscious state. | 1 day of ICU discharge |
| modified Rankin scale at ICU discharge | modified Rankin scale score, with score ranging from 0 (normal) to 6 (death), was used to evaluate the functional outcomes after stroke. | 1 day of ICU discharge |
| modified Rankin scale | modified Rankin scale score, with score ranging from 0 (normal) to 6 (death), was used to evaluate the functional outcomes after stroke, including ordinal mRS, excellent outcome (mRS 0-1), and functional independence (mRS 0-2) | 90 days after enrollment |
Hierarchical composite endpoint of all-cause mortality and post-stroke pneumonia within 7 days |
| 7 days after randomization |
| Time from randomization to the first occurrence of either all-cause death or post-stroke pneumonia | Time from randomization to the first occurrence of either all-cause death or post-stroke pneumonia within 90 days | 90 days after randomization |
| Chongqing |
| Chongqing Municipality |
| China |
| Gansu Provincal Central Hospital | Lanzhou | Gansu | China |
| Nanfang Hospital, Southern Medical University | Guangzhou | Guangdong | China |
| The Second Affiliated Hospital of Guangzhou University of Chinese Medicine | Guangzhou | Guangdong | China |
| The Affiliated Hospital of Guizhou Medical University | Guiyang | Guizhou | 550000 | China |
| First Affiliated Hospital of Zhengzhou University | Zhengzhou | Henan | China |
| Tongji Hospital | Wuhan | Hubei | China |
| The First Hospital of Changsha City | Changsha | Hunan | China |
| The Second Affiliated Hospital of Nanchang University | Nanchang | Jiangxi | 330000 | China |
| General Hospital of Ningxia Medical University | Yinchuan | Ningxia | 750000 | China |
| Shaanxi Second Provincal People's Hospital | Xi'an | Shaanxi | 710000 | China |
| Tangdu Hospital | Xi'an | Shaanxi | 710000 | China |
| The first affiliated hospital of Xi'an Jiaotong University | Xi'an | Shaanxi | 710000 | China |
| Xi'an Central Hospital | Xi'an | Shaanxi | 710000 | China |
| Department of Neurology, Xijing Hospital | Xi'an | Shaanxi | China |
| Shannxi Provincal People's Hospital | Xi'an | Shaanxi | China |
| The First Affiliated Hospital of Xi'an Medical University | Xi'an | Shaanxi | China |
| Xi'an Gaoxin Hospital | Xi'an | Shaanxi | China |
| Xi'an No.3 Hospital | Xi'an | Shaanxi | China |
| Xianyang Hospital, Yan'an University | Xianyang | Shaanxi | 712000 | China |
| The First People's Hospital of Xianyang | Xianyang | Shaanxi | China |
| Yulin No.1 Hospital | Yulin | Shaanxi | China |
| Yulin No.2 Hospital | Yulin | Shaanxi | China |
| Qilu Hospital of Shangdong University | Jinan | Shandong | China |
| The PLA 960 Hospital | Jinan | Shandong | China |
| The Second Hospital of Shandong University | Jinan | Shandong | China |
| Liaocheng People's Hospital | Liaocheng | Shandong | 252000 | China |
| People's Hospital of Xinjiang Uygur Autonomous Region | Ürümqi | Xinjiang | 830000 | China |
| The Second Affiliated Hospital of Xinjiang Medical University | Ürümqi | Xinjiang | 830000 | China |
| 25858238 | Background | Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ, Di Napoli M, Kalra L, Langhorne P, Montaner J, Roffe C, Rudd AG, Tyrrell PJ, van de Beek D, Woodhead M, Meisel A, Smith CJ. How is pneumonia diagnosed in clinical stroke research? A systematic review and meta-analysis. Stroke. 2015 May;46(5):1202-9. doi: 10.1161/STROKEAHA.114.007843. Epub 2015 Apr 9. |
| 29249057 | Background | Suda S, Aoki J, Shimoyama T, Suzuki K, Sakamoto Y, Katano T, Okubo S, Nito C, Nishiyama Y, Mishina M, Kimura K. Stroke-associated infection independently predicts 3-month poor functional outcome and mortality. J Neurol. 2018 Feb;265(2):370-375. doi: 10.1007/s00415-017-8714-6. Epub 2017 Dec 16. |
| 27006423 | Background | Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, Havard D, McFarlane M, McLauglin C, Randall M, Robson K, Scutt P, Smith C, Smithard D, Sprigg N, Warusevitane A, Watkins C, Woodhouse L, Bath PM. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke. 2016 Jun;11(4):399-411. doi: 10.1177/1747493016639057. Epub 2016 Mar 22. |
| 21933425 | Background | Westendorp WF, Nederkoorn PJ, Vermeij JD, Dijkgraaf MG, van de Beek D. Post-stroke infection: a systematic review and meta-analysis. BMC Neurol. 2011 Sep 20;11:110. doi: 10.1186/1471-2377-11-110. |
| 21940613 | Background | Finlayson O, Kapral M, Hall R, Asllani E, Selchen D, Saposnik G; Canadian Stroke Network; Stroke Outcome Research Canada (SORCan) Working Group. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology. 2011 Oct 4;77(14):1338-45. doi: 10.1212/WNL.0b013e31823152b1. Epub 2011 Sep 21. |
| 31238051 | Background | de Montmollin E, Ruckly S, Schwebel C, Philippart F, Adrie C, Mariotte E, Marcotte G, Cohen Y, Sztrymf B, da Silva D, Bruneel F, Gainnier M, Garrouste-Orgeas M, Sonneville R, Timsit JF; OUTCOMEREA Study Group. Pneumonia in acute ischemic stroke patients requiring invasive ventilation: Impact on short and long-term outcomes. J Infect. 2019 Sep;79(3):220-227. doi: 10.1016/j.jinf.2019.06.012. Epub 2019 Jun 22. |
| 28449405 | Background | Suntrup-Krueger S, Kemmling A, Warnecke T, Hamacher C, Oelenberg S, Niederstadt T, Heindel W, Wiendl H, Dziewas R. The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 2: Oropharyngeal residue, swallow and cough response, and pneumonia. Eur J Neurol. 2017 Jun;24(6):867-874. doi: 10.1111/ene.13307. Epub 2017 Apr 27. |
| 30884370 | Background | Al-Khaled M. The multifactorial etiology of stroke-associated pneumonia. J Neurol Sci. 2019 May 15;400:30-31. doi: 10.1016/j.jns.2019.02.042. Epub 2019 Mar 12. No abstract available. |
| 12405628 | Background | McClave SA, DeMeo MT, DeLegge MH, DiSario JA, Heyland DK, Maloney JP, Metheny NA, Moore FA, Scolapio JS, Spain DA, Zaloga GP. North American Summit on Aspiration in the Critically Ill Patient: consensus statement. JPEN J Parenter Enteral Nutr. 2002 Nov-Dec;26(6 Suppl):S80-5. doi: 10.1177/014860710202600613. |
| 16215082 | Background | Jabbar A, Chang WK, Dryden GW, McClave SA. Gut immunology and the differential response to feeding and starvation. Nutr Clin Pract. 2003 Dec;18(6):461-82. doi: 10.1177/0115426503018006461. |
| 30348463 | Background | Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, Preiser JC, van Zanten ARH, Oczkowski S, Szczeklik W, Bischoff SC. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019 Feb;38(1):48-79. doi: 10.1016/j.clnu.2018.08.037. Epub 2018 Sep 29. |
| 28794882 | Background | Uozumi M, Sanui M, Komuro T, Iizuka Y, Kamio T, Koyama H, Mouri H, Masuyama T, Ono K, Lefor AK. Interruption of enteral nutrition in the intensive care unit: a single-center survey. J Intensive Care. 2017 Aug 4;5:52. doi: 10.1186/s40560-017-0245-9. eCollection 2017. |
| 25271389 | Background | Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, Bellingan G, Leonard R, Mythen MG, Rowan KM; CALORIES Trial Investigators. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014 Oct 30;371(18):1673-84. doi: 10.1056/NEJMoa1409860. Epub 2014 Oct 1. |
| 21531737 | Background | Altintas ND, Aydin K, Turkoglu MA, Abbasoglu O, Topeli A. Effect of enteral versus parenteral nutrition on outcome of medical patients requiring mechanical ventilation. Nutr Clin Pract. 2011 Jun;26(3):322-9. doi: 10.1177/0884533611405790. Epub 2011 Apr 29. |
| 29128300 | Background | Reignier J, Boisrame-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, Argaud L, Asehnoune K, Asfar P, Bellec F, Botoc V, Bretagnol A, Bui HN, Canet E, Da Silva D, Darmon M, Das V, Devaquet J, Djibre M, Ganster F, Garrouste-Orgeas M, Gaudry S, Gontier O, Guerin C, Guidet B, Guitton C, Herbrecht JE, Lacherade JC, Letocart P, Martino F, Maxime V, Mercier E, Mira JP, Nseir S, Piton G, Quenot JP, Richecoeur J, Rigaud JP, Robert R, Rolin N, Schwebel C, Sirodot M, Tinturier F, Thevenin D, Giraudeau B, Le Gouge A; NUTRIREA-2 Trial Investigators; Clinical Research in Intensive Care and Sepsis (CRICS) group. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018 Jan 13;391(10116):133-143. doi: 10.1016/S0140-6736(17)32146-3. Epub 2017 Nov 8. |
| 34784064 | Background | Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, McKeever L. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):12-41. doi: 10.1002/jpen.2267. Epub 2022 Jan 3. |
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| 22307571 | Background | National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012 Feb 22;307(8):795-803. doi: 10.1001/jama.2012.137. Epub 2012 Feb 5. |
| 35219379 | Background | Zhao J, Yuan F, Song C, Yin R, Chang M, Zhang W, Zhang B, Yu L, Jia Y, Ma Y, Song Y, Wang C, Song C, Wang X, Shang L, Yang F, Jiang W; OPENS Trial Investigators. Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trial. Lancet Neurol. 2022 Apr;21(4):319-328. doi: 10.1016/S1474-4422(22)00010-2. Epub 2022 Feb 24. |
| Mar 16, 2026 |
| Prot_000.pdf |
| Prot | Yes | No | No | Study Protocol: Original Protocol | Jul 26, 2022 | Mar 16, 2026 | Prot_001.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan: Original SAP | Jul 26, 2022 | Mar 16, 2026 | SAP_002.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan: Final SAP | Jan 20, 2026 | Mar 16, 2026 | SAP_003.pdf |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D003680 | Deglutition Disorders |
| D011014 | Pneumonia |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D004935 | Esophageal Diseases |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D010608 | Pharyngeal Diseases |
| D010038 | Otorhinolaryngologic Diseases |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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