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The Enhanced Protein-Energy Provision via the Enteral Route in Critically Ill Patients

Heyland DK et al.

Historically, feeding protocols have been used to guide the delivery of enteral nutrition but they frequently utilize conservative, reactionary approaches to optimizing nutrition. The result is a form of iatrogenic malnutrition in which critically ill patients consistently receive less than their prescribed nutritional needs. We propose a new approach that protocolizes an aggressive approach to providing enteral nutrition (EN) and shifts the paradigm from reactionary to proactive followed by de-escalation if nutrition therapy is not needed. We already conducted a pilot study that demonstrated that the PEP uP Protocol was safe, and acceptable to nurses. Through the conduct of a cluster randomized controlled trial to take place in 20 Intensive Care Units in Canada and the United States, we will assess the PEP uP Protocol's effect on EN delivery and clinical outcomes, particularly for the patients at the extremes of weight. If found to successfully impact on nutrition, the availability of the PEP UP Feeding Protocol may ultimately lead to less variation in nutrition practice, better quality of care for patients and an improved chance of surviving critical illness

The PEP uP Pilot study is registered at under the ID NCT01102348. The cluster randomized controlled study is registered at under the ID NCT01167595.



Start Date:
 September 2010

Status: Baseline data collection began in September 2010. Sites were randomized in December 2010, and intervention sites attended a training meeting in Vancouver in February, 2011. Follow up data collection was completed in December, 2011.

PEP uP Collaborative: If you are interested in using the PEP uP protocol in your ICU, click here for more information on the PEP uP Collaborative.   

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