Post on 01-Jan-2017
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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