Format

Send to

Choose Destination
JPEN J Parenter Enteral Nutr. 2019 Feb 11. doi: 10.1002/jpen.1521. [Epub ahead of print]

PEP uP (Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol) in Surgical Patients-A Multicenter Pilot Randomized Controlled Trial.

Author information

1
Ryder Trauma Center/University of Miami Miller School of Medicine, Miami, Florida, USA.
2
Clinical Evaluation Research Unit, Kingston General Hospital, Department of Critical Care, Queen's University, Kingston, Ontario, Canada.
3
Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
4
Jamaica Hospital Medical Center, New York City, New York, USA.
5
Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.

Abstract

BACKGROUND:

The Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP) has been shown to be feasible, safe, and effective in delivering significantly more energy/protein, though it has not been well studied in surgical/trauma patients. We hypothesized that PEP uP will effectively increase energy/protein delivery to critically ill surgical/trauma patients.

METHODS:

This multicenter, prospective, randomized pilot study included adult patients admitted to surgical service who were expected to require mechanical ventilation for >24 hours and intensive care unit (ICU) care for >72 hours. Subjects were randomized to PEP uP or standard care. The PEP uP protocol includes initiation at goal rate, semi-elemental formula, prophylactic prokinetic agents, 24-hour volume-based goals, and modular protein supplementation. The primary outcome was nutrition adequacy over the first 12 ICU days.

RESULTS:

Thirty-six subjects were enrolled. Slow recruitment resulted in early trial termination by the sponsor. There were no baseline differences between groups. PEP uP patients received more protein (106.8 ± 37.0 vs 78.5 ± 30.3 g/d, P = 0.02). Energy delivery was not significantly different (1400.0 ± 409.5 vs 1237.9 ± 459.1 kcal, P = 0.25). Vomiting was more common in the PEP uP patients (32% vs 12%, P = 0.03). PEP uP protocol violations included 2 patients (15.4%) not receiving pro-motility medications, 3 (23.1%) not receiving volume-based feeds as ordered, and 4 (30.8%) not receiving supplemental protein.

CONCLUSIONS:

In surgical/trauma patients, PEPuP seemed to improve protein delivery but was difficult to implement successfully and may increase vomiting rates.

KEYWORDS:

PEP uP; nutritional adequacy; surgical

PMID:
30741439
DOI:
10.1002/jpen.1521

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center