Increased protein and energy delivery

TO IMPROVE PATIENT OUTCOMES IN THE ICU

Feed early and adequately with PEP uP

Reduce complications and risks

• Early EN is associated with reduced infectious complications and reduced risk of mortality2,7

• ICU patients who received early EN had a 56% reduced risk of mortality8

Meet nutrition goals with early EN protocols

• Protocols that call for the early introduction of specialized nutrition help patients achieve caloric and protein goals4,6

Increase feeding flexibility

• Switching to a volume-based feeding schedule allows nurses to help each patient reach their individual caloric goals6

Critically ill patients need the right nutrition at the right time to improve recovery.

Caloric and protein deficits are prevalent in critically ill patients1

Inadequate provision of nutrition in ICU patients is associated with increased overall complications, prolonged length of stay (LOS), and increased mortality.2,3

Deferring enteral nutrition (EN) is far too common: 40% to 60% of eligible patients do not receive EN within 48 hours of admission to the ICU.4

Caloric deficit is associated with more days on mechanical ventilation, more complications, and longer stays in the ICU.3,5,6

59%

GREATER RISK OF MORTALITY IN CRITICALLY ILL PATIENTS WHO DID NOT RECEIVE ENTERAL NUTRITION WITHIN THE FIRST 24 HOURS2

Validated EN protocols can help patients receive early and adequate nutrition.

of prescribed calories and protein is associated with improved clinical outcomes9

Feeding

>80%

Protect patients from caloric and protein deficit with early EN

0

30

40

50

Ave

rage

% c

alor

ies

rece

ived

/pre

scri

bed

Baseline Follow-up

Control PEP uP

p<0.0001

p=0.006

Increase in caloric delivery vs. control10

0

30

40

50

Ave

rage

% p

rote

in r

ecei

ved/

pres

crib

ed

Baseline Follow-up

p<0.0001

p=0.003

Control PEP uP

Increase in protein provision vs. control10

37.5% 38.2%

Support early EN from day 1 with the PEP uP* protocol

6 ELEMENTS OF IMPLEMENTATION:

Feed early and adequately with the PEP uP protocol10

SIGNIFICANT INCREASE IN CALORIC AND PROTEIN DELIVERY10

PEPTAMEN® 1.5 formula and BENEPROTEIN® Instant Protein Powder supplements were recommended for the intervention group in the PEP uP study.6†

*Enhanced Protein-Energy Provision via the Enteral Route in Critically Ill Patients (PEP uP).†Prospective, randomized trial of 1059 mechanically ventilated, critically ill patients from 18 ICUs.10

Increased delivery of vital nutrients in ICU patients can have a positive effect on recovery.3

START with a well-tolerated,

high-protein formula

Initiate at 25 mL/hr and advance to full rate by day 2, as tolerated

Employ 24-hour, volume-based

feeding on day 2 to achieve nutrition

goals

Utilize protein

supplements for patients

with increased protein needs

Liberalize gastric residual volume

monitors to 250 mL

Incorporate prokinetic agents

with feeding to improve GI tolerance

Peptamen®1.5

Beneprotein® Peptamen®1.5

Critically ill patients need the right nutrition at the right time to improve recovery.

Caloric and protein deficits are prevalent in critically ill patients1

Inadequate provision of nutrition in ICU patients is associated with increased overall complications, prolonged length of stay (LOS), and increased mortality.2,3

Deferring enteral nutrition (EN) is far too common: 40% to 60% of eligible patients do not receive EN within 48 hours of admission to the ICU.4

Caloric deficit is associated with more days on mechanical ventilation, more complications, and longer stays in the ICU.3,5,6

59%

GREATER RISK OF MORTALITY IN CRITICALLY ILL PATIENTS WHO DID NOT RECEIVE ENTERAL NUTRITION WITHIN THE FIRST 24 HOURS2

Greater mean caloric delivery vs. control10

• Intervention sites (PEP uP): 32% at baseline, 44% at follow-up

• Control sites: 34% at baseline, 34% at follow-up

Greater mean protein provision vs. control10

• Intervention sites (PEP uP): 34% at baseline, 47% at follow-up

• Control sites: 34% at baseline, 34% at follow-up

relative improvement in caloric delivery

at follow-up(vs. 0% control)10

relative improvement in protein provision

at follow-up(vs. 0% control)10

PEP uP Study

FPOFPO

FPO

FEEDING SCHEDULE AND INITIATION ORDER FORM BEHIND

FPO

Providing the right nutrition right from the start. That’s the

GENERAL

PILLAR

SOLUTION

ASSESS

CHOOSE

TRANSITION

The need to standardize care

Evidence-based nutrition protocols

To a higher level of quality

FACTOR INNUTRITION

GENERAL FACTOR INNUTRITION

Transition to a higher standard of care

FACTOR INNUTRITION

Assess patients with validated screening tools

Choose protocols that include evidence-based nutrition

FACTOR INNUTRITION

Transition to a lower risk of pneumonia

Assess risk of dysphagia with EAT-10

Choose modified liquids and foods

Assess the risks associated with delayed EN

Choose a formula that supports tolerance and successful early EN

Transition to a studied protocol that promotes early EN

References: 1. Heyland DK et al. Crit Care Med. 2011;39:2619-2626. 2. Doig GS et al. Intensive Care Med. 2009;35:2018-2027. 3. Villet S et al. Clin Nutr. 2005;24:502-509. 4. Heyland DK et al. J Parenter Enteral Nutr. 2010;34:675-684. 5. Dickerson RN. Nutr Clin Pract. 2011;26:48-54. 6. Heyland DK et al. Crit Care. 2010;14:R78. 7. Marik PE et al. Crit Care Med. 2001;29:2264-2270. 8. Barr J et al. Chest. 2004;125:1446-1457. 9. Heyland DK. Curr Opin Clin Nutr Metab Care. 2013;16:176-181. 10. Heyland DK et al. Poster 56; A.S.P.E.N. Clinical Nutrition Week 2012.

BENEPROTEIN® Instant Protein Powder is made with high-quality whey protein to support increased protein needs.

PEPTAMEN® formulas can help make the early enteral nutrition (EN) connection. Scan to see the mechanism of action.

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