Timing of Stopping Tube Feeding Before Surgery

Overseen By Antoinette Burger, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Jeffrey Coughenour

Disqualifiers: Gastric obstruction, Bowel obstruction, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

120 Participants Needed

Trial Summary

What is the purpose of this trial?

There is currently limited guidance on when to hold nutritional supplementation through for patients, who are receiving tube feeding, undergoing surgical procedures. This study aims to investigate which time would be the best to stop nutrition, if at all, before undergoing a surgical procedure.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It focuses on the timing of stopping tube feeding before surgery.

What data supports the effectiveness of the treatment No DIET Trial: Dogmatic Interruption of Enteral nuTrition?

Research suggests that early feeding after surgery, rather than prolonged fasting, does not increase complications and may improve recovery, as seen in studies on colorectal surgery. This implies that stopping tube feeding closer to surgery time might be safe and beneficial. ^{1 2 3 4 5}

Is it safe to stop tube feeding before surgery?

Research suggests that stopping tube feeding before surgery is generally safe, as fasting does not provide benefits after gastrointestinal surgery and does not increase complications. Studies also indicate that early feeding is recommended and does not lead to more postoperative issues. ^{1 2 6 7 8}

How does the timing of stopping tube feeding before surgery differ from other treatments?

This treatment is unique because it explores the possibility of continuing tube feeding right up until surgery, unlike the standard practice of stopping oral intake 8 hours before surgery. This approach could improve patient comfort and nutrition without increasing surgical risks. ^{1 2 9 10 11}

Research Team

Jeffrey Coughenour, MD

Principal Investigator

University of Missouri-Columbia

Eligibility Criteria

This trial is for patients who receive tube feeding due to gastrostomy or need tracheostomy care and are scheduled for a surgical procedure. The study excludes those with specific dietary requirements, allergies to the feeding formula, or conditions that might interfere with the trial outcomes.

Inclusion Criteria

I need or have a tracheostomy or a feeding tube.

I am over 18 years old.

Exclusion Criteria

Patients unable to receive enteral nutrition

Patients who are pregnant and/or breastfeeding

I have a blockage in my stomach or intestines.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-Surgical Nutrition Management

Participants' enteral nutrition is managed and potentially stopped at different time points prior to surgical procedures

0-8 hours

Surgical Procedure

Participants undergo tracheostomy and/or PEG placement

1 day

Follow-up

Participants are monitored for safety and effectiveness after the surgical procedure

4 weeks

Treatment Details

Interventions

• No DIET Trial: Dogmatic Interruption of Enteral nuTrition

Trial Overview The No DIET Trial investigates when to stop tube feeding before surgery. It compares several approaches: not stopping nutrition until reaching the OR, halting it when called to OR, or ceasing it 4, 6, or 8 hours beforehand.

Participant Groups

Group I: Patients receiving naso-enteral feeding, scheduled for PEG placement. Experimental Treatment 2 Interventions

Group II: Patients receiving PEG nutrition, scheduled for tracheostomy placement. Experimental Treatment 2 Interventions

Who Is Running the Clinical Trial?

Jeffrey Coughenour

Lead Sponsor

Trials

1

Recruited

120+

Findings from Research

A service improvement project in a London ICU showed that implementing a fasting guideline significantly reduced interruptions to enteral nutrition delivery, particularly during airway procedures.

The guideline not only decreased fasting times but also led to a notable reduction in calorie deficits for critically ill patients, improving their overall nutrition delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimising enteral nutrition in critically ill patients by reducing fasting times. Segaran, E., Barker, I., Hartle, A.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Enteral nutrition discontinuation and outcomes in general critically ill patients. [2022]

2. Spain pubmed.ncbi.nlm.nih.gov

[Evidence of early oral feeding in colorectal surgery]. [2019]

3. China pubmed.ncbi.nlm.nih.gov

[Effect of early oral enteral nutrition on clinical outcomes after colorectal cancer surgery]. [2013]

4. Scotland pubmed.ncbi.nlm.nih.gov

Outcomes of early enteral feeding in patients after curative colorectal cancer surgery: A retrospective comparative study. [2021]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Enteral Access is not Required for Esophageal Cancer Patients Undergoing Neoadjuvant Therapy. [2017]

6. England pubmed.ncbi.nlm.nih.gov

Optimising enteral nutrition in critically ill patients by reducing fasting times. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Periprocedural cessation of nutrition in the intensive care unit: opportunities for improvement. [2021]

8. Germany pubmed.ncbi.nlm.nih.gov

Effects of different preoperative enteral nutrition feeding routes on the duration of gastrointestinal decompression after definitive surgery for small intestinal fistula. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

A pilot study to explore the safety of perioperative postpyloric enteral nutrition. [2012]

10. United States pubmed.ncbi.nlm.nih.gov

Jejunostomy tube feedings should not be stopped in the perioperative patient. [2017]

11. France pubmed.ncbi.nlm.nih.gov

[Early jejunal catheter feeding in heavy gastrointestinal surgery (author's transl)]. [2006]