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Products & Applications Early Enteral Feeding with a PEPTAMEN® Formula (PEP uP)

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

Heyland DK, Cahill NE, Dhaliwal R, Wang M, Day AG, Alenzi A, Aris F, Muscedere J, Drover JW, McClave SA

Critical Care 2010;14:R78

Summary prepared by Nestlé Nutrition.
 
For a complete copy of the study, click here.

Click here to view a video clip of Dr. Daren Heyland discussing the PEP uP Feeding Protocol. Click here to view a video clip of Dr. Daren Heyland discussing the PEP uP Feeding Protocol.

Objective
To assess the feasibility, acceptability, and safety of a new feeding protocol designed to aggressively enhance the delivery of early enteral nutrition (EN).

Methods

  • A prospective, single center, before and after study evaluated a new feeding protocol (PEP uP*) compared to a standard feeding protocol.  Innovative elements of the new protocol included:

Innovative elements of the PEP uP feeding protocol

  • The formula used in the study was PEPTAMEN® 1.5 Complete High-Calorie Elemental Nutrition, a formula that would be useful in both full volume and trophic fed patients, and expected to be tolerated by most patients.
  • The protein supplement used was RESOURCE® BENEPROTEIN® Instant Protein Powder.  Although motility agents and protein supplements were meant to start on day 1 for all PEP uP protocol patients, in reality this only happened in about one-third of patients.
  • Mechanically ventilated adult patients who stayed in the ICU for more than 3 days were enrolled in the study (n=20 in the before group, n=30 in the after group).
  • Bedside nurses filled out questionnaires to assess the acceptability and safety of the new approach in order to determine if the primary objective of the study had been met.
  • Secondary outcomes included nutritional endpoints (adequacy of EN and timeliness of initiation of EN) and safety endpoints (episodes of vomiting, aspiration and pneumonia). 

Results

  • No incidents compromising patient safety were observed.
  • The rates of vomiting, regurgitation, aspiration, and pneumonia were similar between the 2 groups.
  • On a scale where 1=totally unacceptable and 10=totally acceptable, 30 nurses rated the new overall protocol as 7.1 (range 1-10).
  • On average, patients in the before group received 58.8% of their energy and 61.2% of their protein requirements from EN during the first 7 ICU days, compared to 67.9% and 73.6% in the after group (P=0.33 and 0.13; no significant difference).  However, enhanced delivery of early EN was seen in the subgroup of patients prescribed to receive full volume feeds, specifically:

Enhanced Delivery Chart

Conclusion
Investigators concluded the new PEP uP feeding protocol was safe, feasible, and found acceptable by critical care nurses.  The adoption of this protocol may be associated with enhanced delivery of early EN, but further trials are warranted to fully evaluate its effect on nutritional and clinical endpoints.

Learn More
For further reading about Dr. Heyland's efforts to improve the practice of nutrition therapies in the critical care setting, visit criticalcarenutrition.com.  You can also download a free copy of the SCCM-A.S.P.E.N. 2009 Critical Care Nutrition Guidelines here

1. Heyland DK et al. Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol.  Critical Care 2010;14:R78


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