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Open Access 01-04-2010 | Research

Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol

Authors: Daren K Heyland, Naomi E Cahill, Rupinder Dhaliwal, Miao Wang, Andrew G Day, Ahmed Alenzi, Fiona Aris, John Muscedere, John W Drover, Stephen A McClave

Published in: Critical Care | Issue 2/2010

Abstract

Introduction

The purpose of this pilot study is to assess the feasibility, acceptability, and safety of a new feeding protocol designed to enhance the delivery of enteral nutrition (EN).

Methods

In a prospective before and after study, we evaluated a new protocol compared to our standard feeding protocol. Innovative elements of the new protocol included setting daily volume based goals instead of hourly rate targets, initiating motility agents and protein supplements on Day 1, liberalizing the gastric residual volume threshold, and the option to use trophic feeds. Bedside nurses filled out questionnaires to assess the acceptability of the new approach and we assessed patients' nutritional and clinical outcomes.

Results

We enrolled 20 mechanically ventilated patients who stayed in the Intensive Care Unit for more than three days in the before group and 30 such patients in the after group. On a scale where 1 = totally unacceptable and 10 = totally acceptable, 30 nurses rated the new protocol as 7.1 (range 1 to 10) and no incidents compromising patient safety were observed. In the before group, on average, patients received 58.8% of their energy and 61.2% of their protein requirements by EN compared to 67.9% and 73.6% in the after group (P = 0.33 and 0.13). When the subgroup of patients prescribed to receive full volume feeds in the after group were evaluated (n = 18), they received 83.2% and 89.4% of their energy and protein requirements by EN respectively (P = 0.02 for energy and 0.002 for protein compared to the before group). The rates of vomiting, regurgitation, aspiration, and pneumonia were similar between the two groups.

Conclusions

This new feeding protocol seems to be safe and acceptable to critical care nurses. The adoption of this protocol may be associated with enhanced delivery of EN but further trials are warranted to evaluate its effect on nutritional and clinical endpoints.

Trial registration

ClinicalTrials.gov NCT01102348

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Title: Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol
Authors: Daren K Heyland
Naomi E Cahill
Rupinder Dhaliwal
Miao Wang
Andrew G Day
Ahmed Alenzi
Fiona Aris
John Muscedere
John W Drover
Stephen A McClave
Publication date: 01-04-2010
Publisher: BioMed Central
Published in: Critical Care / Issue 2/2010
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc8991

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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