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

Yeh, D. Dante; Ortiz, Luis A.; Lee, Jae Moo; Chan, Jeffrey; McKenzie, Katherine; Young, Brian C.; Chetelat, Lindsay; Collier, Bryan R.; Benson, Andrew D.; Heyland, Daren K.

doi:10.1002/jpen.1521

Cited by 21 publications

(12 citation statements)

References 29 publications

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“…PEP uP patients received more protein (106.8 ± 37.0 vs 78.5 ± 30.3 g/d; p ¼ 0.02), whereas energy delivery was not significantly different (1400.0 ± 409.5 vs 1237.9 ± 459.1 kcal; p ¼ 0.25). Vomiting was more common in PEP uP patients (32% vs 12%; p ¼ 0.03) and authors cited that although the protocol was effective in increasing protein intakes, it was difficult to implement [107]. The results of this study suggest achieving high-protein intake via EN alone may be difficult in clinical practice.…”

Section: Enteral Nutritionmentioning

confidence: 76%

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Review of evolution and current status of protein requirements and provision in acute illness and critical care

et al. 2021

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Nutrition therapy, by enteral, parenteral, or both routes combined, is a key component of the management of critically ill, surgical, burns, and oncology patients. Established evidence indicates overfeeding (provision of excessive calories) results in increased risk of infection, morbidity, and mortality. This has led to the practice of "permissive underfeeding" of calories; however, this can often lead to inadequate provision of guideline-recommended protein intakes. Acutely ill patients requiring nutritional therapy have high protein requirements, and studies demonstrate that provision of adequate protein can result in reduced mortality and improvement in quality of life. However, a significant challenge to adequate protein delivery is the current lack of concentrated protein solutions. Patients often have fluid administration restrictions and existing protein solutions are frequently not sufficiently concentrated to deliver a patient's protein requirements. This has led to the development of new enteral and parenteral nutrition solutions incorporating higher levels of protein in smaller volumes. This review article summarizes current evidence supporting the role of higher protein intakes, especially during the early phases of nutrition therapy in acute illness, methods for assessing protein requirements, as well as, the currently available high-protein enteral and parenteral nutrition solutions. There is sufficient evidence (albeit limited from true randomized, controlled studies) to indicate that earlier provision of guidelinerecommended protein intakes may be key to improving patient outcomes and that nutritional therapy that tailors caloric and protein intake to the patients' needs should be considered a desired standard of care.

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Section: Enteral Nutritionmentioning

confidence: 76%

“…The multicentre, prospective, randomized pilot study (PEP uP; N ¼ 36) assessed the PEP uP protocol, which included initiation at goal rate, semi-elemental formula, prophylactic prokinetic agents, 24-h volume-based goals, and modular protein supplementation [107]. Slow recruitment resulted in early trial termination by the sponsor.…”

Section: Enteral Nutritionmentioning

confidence: 99%

Review of evolution and current status of protein requirements and provision in acute illness and critical care

et al. 2021

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“…However, previous observational studies including worldwide surveys [6,7] showed that nutrition targets, especially for protein, were often never achieved and with a number of barriers limiting adequate nutrition therapy [8,9]. Some approaches related to ICU administrative structures, such as dietitian participation [10] or nutrition protocols [11], may contribute to achieving nutrition targets.…”

Section: Introductionmentioning

confidence: 99%

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Nakamura

Liu

Katsukawa³

et al. 2022

Clinical Nutrition

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Background Nutrition therapy for Intensive Care Unit (ICU) patients involves complex decision-making, especially during the COVID-19 pandemic. We investigated the use of nutrition therapy in ICU patients with and without COVID-19 infections. Methods Nutrition therapy was evaluated during a world-wide one-day prevalence study focused on implementation of the ABCDEF bundle (A: regular pain assessment, B: both spontaneous awakening and breathing trials, C: regular sedation assessment, D: regular delirium assessment, E: early mobility and exercise, and F: family engagement and empowerment) during the COVID-19 pandemic. Basic ICU and patient demographics including nutrition therapy delivery were collected on the survey day. Physical activity for patients with and without COVID infections was categorized using the ICU mobility scale (IMS). Multivariable regression analysis of nutrition was conducted using ICU parameters. Results The survey included 627 non-COVID and 602 COVID patients. A higher proportion of COVID-19 patients received energy ≥ 20 kcal/kg/day (55% vs. 45%; p=0.0007) and protein ≥1.2 g/kg/day (45% vs. 35%; p=0.0011) compared to non-COVID patients. Enteral nutrition was provided to most COVID patients even with prone positioning (91%). Despite nutrition therapy, IMS was extremely low in both groups; median IMS was 1 in non-COVID patients and 0 in COVID patients. The rate of energy delivery ≥ 20kcal/kg/day was significantly higher in patients with COVID-19 infections in the subgroup of ICU days ≤ 5 days and IMS ≤ 2. Having a dedicated ICU nutritionist/dietitian was significantly associated with appropriate energy delivery in patients both with and without COVID-19 infections, but not with protein delivery. Conclusion During the COVID-19 pandemic, patients with COVID-19 infections received higher energy and protein delivery. Generally low mobility levels highlight the need to optimize early mobilization with nutrition therapy in all ICU patients.

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“…We then performed a meta‐analysis using 6 RCTs. 631 , 632 , 633 , 634 , 635 , 636 The estimated values of the desirable anticipated effects were as follows: mortality yielded a RD of 4 fewer per 1,000 (95%CI: 51 fewer to 62 more) (5 RCTs, n = 730), physical function evaluation yielded a MD of 0.45 higher (95%CI: 4.57 lower to 5.46 higher) (3 RCTs, n = 489), and muscle mass yielded an MD of 0.2 higher (95%CI: 0.56 lower to 0.96 higher) (2 RCTs, n = 157). It was adjudged that the desirable anticipated effects were trivial.…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created as revised from J‐SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high‐quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J‐SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU‐acquired weakness [ICU‐AW], post‐intensive care syndrome [PICS], and body temperature management). The J‐SSCG 2020 covered a total of 22 areas with four additional new areas (patient‐ and family‐centered care, sepsis treatment system, neuro‐intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large‐scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE‐based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J‐SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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

Cited by 21 publications

References 29 publications

Review of evolution and current status of protein requirements and provision in acute illness and critical care

Review of evolution and current status of protein requirements and provision in acute illness and critical care

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

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