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Critical IllnessFEEDSNCT06751043

Preoperative Fasting vs. Not Fasting in Critically Ill Patients

A study testing Fasting and Not fasting in people with Critical Illness and Surgical Procedure, Unspecified, run by Massachusetts General Hospital at 19 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The goal of this clinical trial is to learn if fasting or not fasting before a procedure has an effect on recovery in those who are critically ill. The main questions it aims to answer for patients on a breathing machine who are receiving tube feeding are: Does the risk of lung complications and death differ between… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Fasting and Not fasting
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,072 participants
Where
19 sitesUnited States
Study dates
28 Apr 2025to May 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 1. Age ≥ 18
  • Current admission to ICU*
  • Secure airway** with no plans for its removal prior to procedure
  • Current non-trophic (> 10 mL/hr) tube (enteral) feeding*** with no plans to discontinue prior to procedure for reasons other than preoperative fasting
  • Planned eligible procedure (Examples are listed in Appendix C) with anesthesia care or nursing sedation. Eligible procedures are defined as non-emergent diagnostic or therapeutic interventions that:
  • Do NOT have a well-established practice of preoperative fasting. (For example, bedside placement of a vascular catheter [arterial, central venous, peripheral venous] by the ICU team is NOT eligible for this trial since it has a widely established practice of no preoperative fasting and is not generally scheduled for a specific time.)
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  • Do NOT require fasting for preoperative gastrointestinal tract preparation
  • Do NOT require removal/replacement of the endotracheal or tracheostomy tube
  • Do NOT require prone or Trendelenburg (head-down) positioning.
  • Typically require procedural sedation or anesthesia care.
  • Generally, are scheduled for a specific time (although this time can change, or procedure may be cancelled).
  • Are performed in the operating room, non-operating room procedural areas, or at the patient's bedside.
  • All ICU types are eligible: surgical, medical, cardiac, neurological, trauma, mixed etc.
  • Secure airway is defined as a cuffed endotracheal tube or a cuffed tracheostomy tube.
  • Patients with all types of feeding tubes are eligible, regardless of tube insertion site (nasal, oral, surgically implanted) and tube tip location (pre- and post-pyloric) †As determined by the enrolling physician-investigator

Who cannot join

  • Inability to obtain informed consent
  • Inability to enroll and randomize > 8 hours prior to planned procedure time
  • Inability to deliver trial interventions
  • Expected survival < 48 hours as determined by the enrolling physician-investigator
  • Critically ill burn patient
  • Emergency procedure
Show all 15Show fewer
  • a. Gastrointestinal tract procedure that requires fasting based on surgical indications or b. airway/lung procedure that requires removal of endotracheal or tracheostomy tube
  • Plan for prone or Trendelenburg (head down) positioning during most of the procedure
  • Major impairment of gastrointestinal motility or major structural disease of the gastrointestinal tract (e.g., severe gastroparesis, bowel obstruction, severe ileus, severely compromised lower esophageal sphincter, active gastrointestinal bleeding)
  • Plan for postoperative extubation in the procedure area
  • Prisoner
  • Pregnant woman, woman of childbearing potential without a documented negative urine or serum pregnancy test during the current hospitalization, or woman who is breast feeding
  • Refusal to enroll patient by treating physician
  • Extracorporeal Membrane Oxygenation (ECMO) at the time of potential enrollment, except patients scheduled for ECMO decannulation as the study procedure and patients expected to be off of ECMO at the time of study procedure.
  • Chronic mechanical ventilation at pre-admission level of care

Trial locations and contacts

19 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Alexander Nagrebetsky, MD, MSC contact

617-724-3292

anagrebetsky@mgh.harvard.edu

19 sites in 1 country

United States19 sites, 18 recruiting
  • University of Colorado Medical Center

    Aurora, Colorado, 80045

    Ana Fernandez-Bustamante, MD, PhD, FASA, 720-848-0000

    Not yet recruiting
  • University of Maryland Medical Center

    Baltimore, Maryland, 21201

    Megan Anders, MD, (410) 328-8600, manders@som.umaryland.edu

    Not yet recruiting
  • Mass General Hospital

    Boston, Massachusetts, 02114

    Alex Nagrebetsky

    Recruiting
  • Brigham & Women's Hospital

    Boston, Massachusetts, 02115

    Gyorgy Frendl

    Recruiting
  • McGaw Medical Center of Northwestern

    Chicago, Illinois, 60611

    Ravindra Gupta, MD, FASA, FCCP, (312) 503-7975, Ravindra.Gupta@nm.org

    Recruiting
  • Rush University Medical Center

    Chicago, Illinois, 60612

    Alisha Sachdev, MD, (888) 352-7874, Alisha_Sachdev@rush.edu

    Recruiting
  • Cleveland Clinic

    Cleveland, Ohio, 44195

    Active, not recruiting
  • University of Texas Medical Branch

    Galveston, Texas, 77555

    Marcos Vidal Melo, MD, PhD, 409-772-1011, mfvidalm@UTMB.EDU

    Recruiting
  • UT Health Houston

    Houston, Texas, 77030

    Turan Mehmet, MD, 713-486-1000, mehmet.a.turan@uth.tmc.edu

    Not yet recruiting
  • University of Miami Hospital

    Miami, Florida, 33136

    Alexander Fort III, MD, 305-243-4000, acfort@med.miami.edu

    Not yet recruiting
  • University of Minnesota Medical Center

    Minneapolis, Minnesota, 55455

    Benjamin Keith, MD, 855-324-7843, keith200@umn.edu

    Recruiting
  • Columbia University Irvine Medical Center

    New York, New York, 10032

    Vivek Moitra, MD, FASA, FCCP, (212) 305-2500, vm2161@cumc.columbia.edu

    Recruiting
  • Memorial Sloan Kettering Cancer Center

    New York, New York, 10065

    David Amar, MD, 212-639-2000, amard@mskcc.org

    Recruiting
  • Stanford Medical Center

    Palo Alto, California, 94305

    Pedro Tanaka, MD, PhD, MACM, (650) 498-6000, ptanaka@stanford.edu

    Recruiting
  • University of Rochester Medical Center

    Rochester, New York, 14642

    Jacob Nadler, MD, PhD, FASA, (585) 275-2100, Jacob_Nadler@URMC.Rochester.edu

    Not yet recruiting
  • UCSF Medical Center Parnassus

    San Francisco, California, 94143

    Lee-lynn Chen, MD, (415) 567-6600, Lee-lynn.Chen@ucsf.edu

    Recruiting
  • Montefiore Medical Center

    The Bronx, New York, 10467

    Michael Kiyatkin, MD, 718-920-4321, mkiyatkin@montefiore.org

    Recruiting
  • Wake Forest University Health Sciences

    Winston-Salem, North Carolina, 27103

    Ashish Khanna, MD, FCCP, FCCM, 336-758-5000, akhanna@wakehealth.edu

    Recruiting
  • University of Massachusetts Memorial Medical Center

    Worcester, Massachusetts, 01655

    Guido Musch, MD, MBA, (508) 334-1000, Guido.Musch@umassmed.edu

    Recruiting

Other trials in United States

About this study

Official title: FEEDS Trial - Fasting Preprocedurally in Enteral Nutrition: Evaluation of Divergent Approaches in Secure Airway

The goal of this clinical trial is to learn if fasting or not fasting before a procedure has an effect on recovery in those who are critically ill. The main questions it aims to answer for patients on a breathing machine who are receiving tube feeding are:

  • Does the risk of lung complications and death differ between those who are not fasting, which may have a higher chance of allowing tube feeding to enter the lungs, and fasting, which temporarily stops nutrition before a procedure?
  • Is there a difference in recovery times, hospital stays, infection rates, need for organ support, safety, and nutrition for those who either fast or do not fast before a procedure?
  • What is the relationship between nutrition and clinical outcomes?
Read more

Researchers will compare not fasting and fasting to see if it has an effect on recovery.

Participants will:

  • Be assigned by chance (like a coin toss) to one of two groups. One group (fasting group) will have their tube feeding stopped at least 8 hours before their procedure. The other group (not fasting group) will have their tube feeding stopped right before their procedure.
  • Be monitored via medical record for amount of protein and calories received, and any complications related to fasting/not fasting.
  • Data from routine electronic medical records will be reviewed to determine how participants are doing 3 months after their procedure.

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Read the detailed description

Patient Population: Critically ill patients in the ICU who are: mechanically ventilated, receiving tube feeding (enteral nutrition), with a planned surgery or procedure. Up to 1072 subjects will be enrolled.

Phase III pragmatic multicenter parallel-group randomized controlled non-inferiority trial with patient-level randomization and assessor blinding.

Enrollment Period: Approximately two years.

Aims:

  • Aim 1: To compare the risk of pulmonary complications and mortality from: (1) perioperative pulmonary aspiration6,33,34 due to not fasting vs. (2) systemic effects of nutritional loss18-24 due to preoperative fasting. We will quantify the risk of pulmonary complications and mortality as the number of postoperative days alive and free from mechanical ventilation (DAFV)35,36 in the target population of critically ill patients with a secure airway who undergo interventional procedures.
  • Aim 2: To compare length of ICU and hospital stay, discharge to home, need for organ support, infectious complications, safety outcomes, and nutritional outcomes in tube-fed mechanically ventilated patients with a secure airway who are fasted vs. not fasted prior to procedure.
  • Aim 3: To define the relationship between perioperative fasting duration, calorie/protein delivery, and clinical outcomes in mechanically ventilated patients who receive tube feeding.

Study participants will be randomized with a 1:1 allocation ratio to one of the following preprocedural interventions:

  1. Fasting - stopping tube feeding at least 8 hours prior to the scheduled procedure time;
  2. Not fasting - tube feeding until call for transfer to the procedure area.
Being tested
Fasting, Not fasting
Keywords
pulmonary aspiration, enteral nutrition, tube feeding, preoperative fasting, perioperative medicine, surgery in critically ill, procedures in critically ill, nutrition in critical illness, perioperative safety, preoperative management, preoperative fasting in secure airway, anesthesia in critically ill
Medical subject headings
Critical Illness, Fasting

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • FastingOther

    Process: Fasting pre-procedure

    Tube feeding will be stopped at least 8 hours before the patient's scheduled surgery or procedure time.

  • Not fastingOther

    Process: Not fasting pre-procedure

    Tube feeding will be continued until patient transfer to the operating room/procedure area.

Study groups in NCT06751043
Study groupRoleWhat they receive
FastingActive comparatorPatients randomized to the Fasting arm will have tube feeding stopped at least 8 hours before the scheduled surgery or procedure time.
Receives: Other: Fasting
Not FastingActive comparatorPatients randomized to the Not Fasting arm will have tube feeding continued until transfer to the operating room/procedure area.
Receives: Other: Not fasting

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Days alive and free from mechanical ventilation on postoperative day 28.

    Defined as the days alive and free of organ support (dialysis, assisted ventilation, and vasopressors) to day 28. Participants will need to be free of all three components (assisted ventilation, vasopressors, new renal replacement therapy) to qualify for a day alive and free from organ failures. Patients on chronic dialysis will not be scored for the new renal failure free component of this outcome.

    Measured: Post-operative day 28

Secondary outcomes (21)
  1. Postoperative mortality

    Death from any cause at any location, including deaths after withdrawal of care.

    Measured: Post-operative day 28

  2. Ventilator-free days in survivors

    28 minus last post-operative day of mechanical ventilation assessed only in survivors at post-operative day 28. Non-survivors are excluded

    Measured: Post-operative day 28

  3. All-cause, all-location mortality

    Death from any cause at any location, including deaths after withdrawal of care.

    Measured: Post-operative day 90

  4. Length of ICU stay

    90 minus the last post-operative day of ICU admission.

    Measured: Post-operative day 90

  5. Length of hospital stay

    90 minus the last post-operative day of hospital/facility admission.

    Measured: Post-operative day 90

  6. Days alive and without life support54 Days alive and without life support

    90 minus the last post-operative day of mechanical ventilation, renal replacement therapy, or circulatory support (ECMO, vasopressor or inotrope), whichever is used last.

    Measured: Post-operative day 90

  7. Proportion of patients alive and at home

    Proportion of patients who are alive and at home or at pre-index hospitalization level of care.

    Measured: Post-operative day 90

  8. New surgical site infection

    Documentation of superficial incisional or organ/space infection after index procedure in routine medical records

    Measured: Post-operative day 90

  9. New bacteremia

    Bacteremia in patients without pre-study intervention evidence of bacteremia during the same hospital admission.

    Measured: Post-operative day 90

  10. Perioperative pulmonary aspiration

    Periprocedural pulmonary aspiration of gastric contents documented in routine medical records.

    Measured: Time of procedure start +/- 24 hours

  11. Perioperative Hyperglycemia

    Routinely collected blood glucose of > 180 mg/dL on at least one measurement.

    Measured: Time of procedure start +/- 24 hours

  12. Perioperative hypoglycemia

    At least one episode of routinely collected blood glucose of 41 to 70 mg/dL (moderate hypoglycemia) or ≤ 40 mg/dL (severe hypoglycemia).

    Measured: Time of procedure start +/- 24 hours

  13. Preoperative fasting duration

    Time from last routinely documented non-trophic (> 10 mL/hr) tube feeding to procedure start.

    Measured: Time of procedure start - 72 hours

  14. Postoperative fasting duration

    Time from procedure end to the first routinely documented non-trophic (>10 mL/hr) tube feeding volume/rate.

    Measured: Time of procedure start + 72 hours

  15. Perioperative fasting duration

    Duration of preoperative plus postoperative fasting.

    Measured: Time of procedure start +/- 72 hours

  16. Preoperative calories delivered

    Total number of calories delivered via tube feeding within 24 and 72 hours prior to procedure.

    Measured: Time of procedure - 72 and -24 hours

  17. Postoperative calories delivered

    Total number of calories delivered via tube feeding within 24 and 72 hours after the procedure.

    Measured: Time of procedure + 72 and + 24 hours

  18. Perioperative calories delivered

    Total number of calories delivered via tube feeding within 24 and 72 hours of the procedure.

    Measured: Time of procedure +/- 72 and +/- 24 hours

  19. Preoperative protein delivered

    Total amount of protein delivered via tube feeding within 24 and 72 hours prior to procedure.

    Measured: Time of procedure - 72 and -24 hours

  20. Postoperative protein delivered

    Total amount of protein delivered via tube feeding within 24 and 72 hours after the procedure.

    Measured: Time of procedure + 72 and + 24 hours

  21. Perioperative protein delivered

    Total amount of protein delivered via tube feeding within 24 and 72 hours of the procedure

    Measured: Time of procedure +/- 72 and +/- 24 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Dec 2024
  2. Study start28 Apr 2025
  3. Primary completionFeb 2028 (estimated)
  4. Study completionMay 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Phase III pragmatic multicenter parallel-group randomized controlled non-inferiority trial with patient-level randomization and assessor blinding. If non-inferiority is demonstrated, we will perform a pre-specified superiority test.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
1,072 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06751043
Sponsor's protocol ID
2024P003035
Other IDs
BPS-2023C1-31273
Acronym
FEEDS
Status last verified
Jun 2026
First submitted
20 Dec 2024
Last updated
12 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Study sites of this trial will share deidentified data through eCRF with the Statistical and Data Coordinating Center. The shared data will include patient baseline characteristics (clinical and demographic), data on trial interventions, and outcome data.

Questions about this trial

What is this clinical trial studying?

A study testing Fasting and Not fasting in people with Critical Illness and Surgical Procedure, Unspecified, run by Massachusetts General Hospital at 19 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 12 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 19 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Alexander Nagrebetsky, MD, MSC (617-724-3292, anagrebetsky@mgh.harvard.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Days alive and free from mechanical ventilation on postoperative day 28. (time frame: Post-operative day 28). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jun 2026.

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