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

D Dante Yeh1, Luis Alfonso Ortiz2, Jae Moo Lee3

  • 1Ryder Trauma Center/University of Miami Miller School of Medicine, Miami, Florida, USA.

JPEN. Journal of Parenteral and Enteral Nutrition
|February 12, 2019
PubMed

Insights

The Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP) improved protein delivery in surgical patients but faced implementation challenges. This critical care nutrition strategy may also increase vomiting rates.

Area of Science:

  • Critical care medicine
  • Surgical nutrition
  • Intensive care unit (ICU) management

Background:

  • The Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP) is known to be effective but understudied in surgical/trauma patients.
  • Critically ill surgical and trauma patients often require specialized nutritional support to optimize outcomes.

Purpose of the Study:

  • To evaluate the efficacy of the PEP uP protocol in increasing energy and protein delivery to critically ill surgical/trauma patients.
  • To assess the feasibility and safety of implementing the PEP uP protocol in this patient population.

Main Methods:

  • A multicenter, prospective, randomized pilot study involving adult surgical patients requiring mechanical ventilation and ICU care.
  • Patients were randomized to either the PEP uP protocol or standard care.
  • The PEP uP protocol involved early initiation, specific formulas, prokinetics, volume-based goals, and modular protein.

Main Results:

  • The study was terminated early due to slow recruitment.
  • PEP uP patients received significantly more protein (106.8 vs 78.5 g/d).
  • No significant difference in energy delivery was observed; vomiting was more frequent in the PEP uP group (32% vs 12%).
  • Protocol violations were noted in the PEP uP group regarding medications, feeding volume, and protein supplementation.

Conclusions:

  • The PEP uP protocol showed potential for improving protein delivery in surgical/trauma patients.
  • Successful implementation of the PEP uP protocol was challenging, with several deviations from the intended protocol.
  • The protocol may be associated with an increased risk of vomiting in this patient population.
Abstract

Keywords:
PEP uPnutritional adequacysurgical

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