title: Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol.
abstract: BACKGROUND
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01102348.
authors.affiliation: Department of Medicine, Queen's University, Kingston, ON, Canada. dkh2@queensu.ca
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Cahill
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.forename: Miao
authors.initials: M
authors.lastname: Wang
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alenzi
authors.forename: Fiona
authors.initials: F
authors.lastname: Aris
authors.forename: John
authors.initials: J
authors.lastname: Muscedere
authors.forename: John W
authors.initials: JW
authors.lastname: Drover
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D016638:Critical Illness; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011506:Proteins / Q000008:administration & dosage*; D011795:Surveys and Questionnaires
chemical_list: D011506:Proteins