Volume‐Based Enteral Nutrition Support Regimen Improves Caloric Delivery but May Not Affect Clinical Outcomes in Critically Ill Patients

Haskins, Ivy N.; Baginsky, Mary; Gamsky, Nathaniel; Sedghi, Kia; Yi, Sojung; Amdur, Richard L.; Gergely, Mary; Sarani, Babak

doi:10.1177/0148607115617441

Cited by 26 publications

(26 citation statements)

References 23 publications

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“…To maximize EN delivery, we first need to minimize the time patients are nil per os with protocols that minimize these interruptions 36 . Then, using existing products and strategies, there are several methods by which practitioners can increase protein/amino administration in the ICU setting: using a high‐protein enteral formula, adding protein supplements to the existing EN order, implementing novel enteral feeding protocols that include protein delivery enhancement strategies and/or volume‐based feeding strategies, 35 , 37 – 40 and supplementation with parenteral amino acids alone or PN 41 . Recently, commercially available high‐protein enteral solutions have become available (35%–37% protein, 88–92 g/L), 42 , 43 and there is emerging evidence that these products may translate into greater protein intake compared with usual care practices cited above 44 , 45 .…”

Section: Current Practicementioning

confidence: 99%

“…An integral part of PEP uP is the concept of volume‐based feeding prescriptions where patients are prescribed the targeted amount expressed as a 24‐hour volume goal. Compared with traditional hourly based targets, volume‐based protocols have been shown to deliver significantly more protein and calories in several before‐after studies of ICU patients 38 – 40 …”

Section: Current Practicementioning

confidence: 99%

See 1 more Smart Citation

Protein Delivery in the Intensive Care Unit: Optimal or Suboptimal?

et al. 2017

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Emerging evidence suggests that exogenous protein/amino acid supplementation has the potential to improve the recovery of critically ill patients. After a careful review of the published evidence, experts have concluded that critically ill patients should receive up to 2.0-2.5 g/kg/d of protein. Despite this, however, recent review of current International Nutrition Survey data suggests that protein in critically ill patients is underprescribed and grossly underdelivered. Furthermore, the survey suggests that most of protein administration comes from enteral nutrition (EN) despite the availability of products and protocols that enhance the delivery of protein/amino acids in the intensive care unit (ICU) setting. While future research clarifies the dose, timing, and composition for exogenous protein administration, as well as identification of patients who will benefit the most, ongoing process improvement initiatives should target a concerted effort to increase protein intake in the critically ill. This assertion follows from the notion that current patients are possibly being harmed while we wait for confirmatory evidence. Further research should also develop better tools to enable bedside practitioners to monitor optimal or adequate protein intake for individual patients. Finally, exploring the effect of combining adequate protein delivery with early mobility and/or resistance exercise in the ICU setting has the greatest potential for improving the functional outcomes of survivors of critical illness and warrants further study.

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Section: Current Practicementioning

confidence: 99%

Section: Current Practicementioning

confidence: 99%

Protein Delivery in the Intensive Care Unit: Optimal or Suboptimal?

et al. 2017

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“…However, most studies are limited by small sample size or lack of adjustment for potential confounding factors . In addition, results regarding the impact of VBEN on increasing delivery of prescribed EN are inconsistent . These limitations warrant further examination of the effect of VBEN on EN delivery.…”

Section: Introductionmentioning

confidence: 99%

“…[24][25][26][27] Volume-based EN (VBEN) is one strategy used to compensate for EN interruptions. 24,[28][29][30][31][32][33][34][35][36] VBEN uses an order for 24 hours (eg, 1200 mL/24 h) vs the traditional hourly infusion rate with rate-based EN (RBEN; eg, 50 mL/h).…”

Section: Introductionmentioning

confidence: 99%

“…24,34 Several studies have assessed effectiveness of VBEN vs RBEN in regard to EN delivery and complications 24,[28][29][30][31]33,35,36 ; to date, they suggest that VBEN, compared with RBEN, increases EN delivery without increasing complications. 24,[28][29][30][31][33][34][35][36] However, most studies are limited by small sample size 24,29,33,35 or lack of adjustment for potential confounding factors. 24,28,33,35,36 In addition, results regarding the impact of VBEN on increasing delivery of prescribed EN are inconsistent.…”

Section: Introductionmentioning

confidence: 99%

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Volume‐Based vs Rate‐Based Enteral Nutrition in the Intensive Care Unit: Impact on Nutrition Delivery and Glycemic Control

Roberts

Brody

Rawal

et al. 2018

J Parenter Enteral Nutr

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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

Yeh

Ortiz

Lee

et al. 2019

J Parenter Enteral Nutr

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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.

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Volume‐Based Enteral Nutrition Support Regimen Improves Caloric Delivery but May Not Affect Clinical Outcomes in Critically Ill Patients

Abstract: VB enteral feeding allows for a significantly greater provision of prescribed calories but may not affect clinical outcomes. A larger sample size is needed for adequate power to corroborate these findings.

Cited by 26 publications

References 23 publications

Protein Delivery in the Intensive Care Unit: Optimal or Suboptimal?

Protein Delivery in the Intensive Care Unit: Optimal or Suboptimal?

Volume‐Based vs Rate‐Based Enteral Nutrition in the Intensive Care Unit: Impact on Nutrition Delivery and Glycemic Control

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

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