New Protocol Improves Nutritional Delivery in Surgical Patients

Enhanced protein-energy provision via the enteral route feeding protocol (PEPuP) helps improve protein and caloric delivery vs standard of care (SOC) in surgical and trauma patients, according to a recent pilot study. However, findings also indicated that protocol violations occurred frequently with PEPuP.

Results from the study were presented at the American Society for Parenterial and Enteral Nutrition (ASPEN) 2018 Nutrition Science and Practice Conference, which is taking place from January 22 to 25 in Las Vegas, Nevada.
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For their study, the researchers identified and screened 832 patients who were expected to require mechanical ventilation for more than 24 hours and intensive care unit (ICU) care for more than 72 hours. Patients were randomly assigned to receive either PEPup or SOC.

Ultimately, 36 of 832 patients were included in the present analysis. Findings showed that patients in the PEPuP group had received more protein vs the SOC group. PEPuP participants received more calories than SOC participants, but this did not reach statistical significance. Additionally, the researchers observed a significantly greater weight-normalized protein delivery in the PEPuP group vs SOC. However, the weight-normalized caloric difference did not reach significance.

Protocol violations were found to be common with PEPuP. Violations occurring during the study included no receipt of prokinetics (2 patients), no receipt of volume-based foods as ordered (3 patients), and no receipt of supplemental protein (4 patients).

The researchers noted that 1 severe event had occurred within the PEPuP group, and that vomiting occurred more commonly in the PEPuP group vs SOC (46% vs 8%).

“In surgical/trauma patients, PEPuP was difficult to implement but it seemed to improve protein and caloric delivery in this underpowered trial,” the researchers concluded.

—Christina Vogt

Reference:

Yeh DD, Ortiz LA, Lee JM, et al. PEPuP (enhanced protein-energy provision via the enteral route feeding protocol) in surgical patients- a multicenter pilot randomized controlled trial. Paper presented at: ASPEN 2018 Nutrition Science and Practice Conference. January 22-25, 2018. Las Vegas, NV. https://www.nutritioncare.org/uploadedFiles/Documents/ASPEN_2018/ASPEN18_Abstracts/NUTRITION AND METABOLISM PAPER SESSIONS 2018.pdf.