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This randomized controlled trial aims to compare the effectiveness of early post-pyloric feeding versus gastric feeding in preventing SAP in patients with severe ischemic stroke. The main question to answer is whether post-pyloric feeding group is better than the gastric feeding group for preventing SAP.
This study adopts a multicenter-center, randomized controlled, parallel-group, open-label trial design. Patients with severe ischemic stroke who meet the inclusion criteria will be randomly assigned to the post-pyloric feeding group (experimental group) or the gastric feeding group (control group). Both groups will receive standard stroke treatment and care. The primary outcome measure is the incidence of SAP, with a follow-up period of 90 days. The sample size is 174 cases, with 87 cases per group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Post-Pyloric Feeding Group | Experimental | A nasoenteric tube (Nuritia, 10Fr) will be placed within 24 hours of admission. The procedure involves elevating the head of the bed to approximately 30-45°, lubricating the tube with liquid paraffin, inserting it into the stomach using a blind insertion technique, then positioning the patient in the right lateral decubitus position. The insertion length will be approximately 75 cm. 200-500 ml of air and warm water will be injected into the stomach to open the pylorus. Gently, as the pylorus opens, the tube will be advanced beyond the ligament of Treitz. Digestive fluid will be aspirated for pH testing. Tube position (post-pyloric) will be confirmed by X-ray before initiating enteral nutrition support. An appropriate nutritional formula will be selected based on the patient's condition. The initial infusion rate will be 20 ml/h using a nutrition pump. The head of the bed will be elevated to 30-45°. Observation will occur continuously for the first hour, then every 4 hours. The rate wi |
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| Gastric Feeding Group | Active Comparator | A nasogastric tube (Nuritia, 14Fr) will be placed within 24 hours of admission. The tube will be lubricated with liquid paraffin, inserted into the gastric cavity using a blind insertion technique, and properly fixed. Correct position will be confirmed by auscultation of air insufflation over the stomach before initiating enteral nutrition support. An appropriate nutritional formula will be selected based on the patient's condition. The initial infusion rate will be 20 ml/h using a nutrition pump. The head of the bed will be elevated to 30-45°. Observation will occur continuously for the first hour, then every 4 hours. The rate will be gradually increased by 10 mL every 4 hours based on patient tolerance until the daily target volume (25-30 kcal/kg/day) is achieved. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Post-Pyloric Feeding | Procedure | A nasoenteric tube (Nuritia, 10Fr) will be placed within 24 hours of admission. The procedure involves elevating the head of the bed to approximately 30-45°, lubricating the tube with liquid paraffin, inserting it into the stomach using a blind insertion technique, then positioning the patient in the right lateral decubitus position. The insertion length will be approximately 75 cm. 200-500 ml of air and warm water will be injected into the stomach to open the pylorus. Gently, as the pylorus opens, the tube will be advanced beyond the ligament of Treitz. Digestive fluid will be aspirated for pH testing. Tube position (post-pyloric) will be confirmed by X-ray before initiating enteral nutrition support. An appropriate nutritional formula will be selected based on the patient's condition. The initial infusion rate will be 20 ml/h using a nutrition pump. The head of the bed will be elevated to 30-45°. Observation will occur continuously for the first hour, then every 4 hours. The rate wil |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of stroke-associated pneumonia within 7 days of onset | The diagnostic criteria for SAP will follow the 2019 Chinese Expert Consensus on the Diagnosis and Treatment of Stroke-Associated Pneumonia. | 7 days of onset. |
| Measure | Description | Time Frame |
|---|---|---|
| Hospital length of stay | Length of patients stay in the hospital | From date of admission to date of discharge, assessed up to 28 days |
| 90-day modified Rankin Scale (mRS) score | The distribution of the 90-day mRS (0;1;2;3;4;5;6) as assessed by structured assessment. |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality within 28 days | Percentage of patients who die within 28 days post-randomization. | 28 days post-randomization. |
| Incidence of Gastrointestinal Complications | Gastrointestinal bleeding, diarrhea, abdominal distension, constipation, vomiting. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yahui Guo, MD | Contact | +86 13951834652 | 1185626794@qq.com | |
| Rui Liu, MD | Contact | +86 15005144515 | liurui8616@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Wusheng Zhu, MD | Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jinling Hospital, Medical School of Nanjing University, Nanjing | Nanjing | Jiangsu | 210002 | China |
Patient information will be de-identified
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D004750 | Enteral Nutrition |
| ID | Term |
|---|---|
| D005248 | Feeding Methods |
| D013812 | Therapeutics |
| D018529 | Nutritional Support |
| D044623 | Nutrition Therapy |
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| Gastric Feeding | Procedure | A nasogastric tube (Nuritia, 14Fr) will be placed within 24 hours of admission. The tube will be lubricated with liquid paraffin, inserted into the gastric cavity using a blind insertion technique, and properly fixed. Correct position will be confirmed by auscultation of air insufflation over the stomach before initiating enteral nutrition support. An appropriate nutritional formula will be selected based on the patient's condition. The initial infusion rate will be 20 ml/h using a nutrition pump. The head of the bed will be elevated to 30-45°. Observation will occur continuously for the first hour, then every 4 hours. The rate will be gradually increased by 10 mL every 4 hours based on patient tolerance until the daily target volume (25-30 kcal/kg/day) is achieved. |
|
| 90 days after randomization |
| Time from admission to achieving enteral nutrition target | Enteral nutrition target is set as 25-30kcal/kg. | From date of admission until enteral nutrition target is achieved, assessed up to 28 days |
| Change from baseline in serum albumin level at Day 14 | Serum albumin will be measured via venous blood sample. | Baseline and Day 14 |
| Change from baseline in serum albumin level at Day 28 | Serum albumin will be measured via venous blood sample | Baseline and Day 28 |
| Change from baseline in white blood cell count at Day 14 | White blood cell count will be measured via venous blood sample. | Baseline and Day 14 |
| Change from baseline in white blood cell count at Day 28 | White blood cell count will be measured via venous blood sample. | Baseline and Day 28 |
| 28 days |
| Catheter-related Complications | Blockage, displacement, dislodgement | 28 days |
| Change from baseline in serum total protein level at Day 14 | Serum total protein level will be measured via venous blood sample. | Baseline and Day 14 |
| Change from baseline in serum prealbumin level at Day 14 | Serum prealbumin level will be measured via venous blood sample. | Baseline and Day 14 |
| Change from baseline in serum transferrin level at Day 14 | Serum transferrin level will be measured via venous blood sample. | Baseline and Day 14 |
| Change from baseline in serum total protein level at Day 28 | Serum total protein will be measured via venous blood sample | Baseline and Day 28 |
| Change from baseline in serum prealbumin level at Day 28 | Serum prealbumin will be measured via venous blood sample | Baseline and Day 28 |
| Change from baseline in serum transferrin level at Day 28 | Serum transferrin will be measured via venous blood sample | Baseline and Day 28 |
| Change from baseline in C-reactive protein level at Day 14 | C-reactive protein will be measured via venous blood sample. | Baseline and Day 14 |
| Change from baseline in interleukin-6 level at Day 14 | Interleukin-6 level will be measured via venous blood sample. | Baseline and Day 14 |
| Change from baseline in body temperature at Day 14 | Body temperature will be recorded at 8:00 AM daily during the hospitalization. | Baseline and Day 14 |
| Change from baseline in interleukin-6 level at Day 28 | Interleukin-6 level will be measured via venous blood sample. | Baseline and Day 28 |
| Change from baseline in C-reactive protein level at Day 28 | C-reactive protein level will be measured via venous blood sample. | Baseline and Day 28 |
| Change from baseline in body temperature at Day 28 | Body temperature will be recorded at 8:00 AM daily during the hospitalization. | Baseline and Day 28 |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |