• Daren K Heyland, Rupinder Dhaliwal, Margot Lemieux, Miao Wang, and Andrew G Day.
• Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada dkh2@queensu.ca.
• JPEN J Parenter Enteral Nutr. 2015 Aug 1; 39 (6): 698-706.

BackgroundPrevious studies have documented widespread iatrogenic underfeeding in intensive care unit (ICU) patients. In an experimental setting, we demonstrated the safety and efficacy of a novel enteral feeding protocol designed to overcome the main barriers to adequate delivery of enteral nutrition (EN), the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP protocol). The purpose of this article is to describe our experience with implementing this feeding protocol under "real-world" settings in Canada.Materials And MethodsThis study is a multicenter quality improvement initiative with a concurrent control group. Selected ICUs implemented the PEP uP protocol, and nutrition practices and outcomes were compared with a concurrent control group of ICUs.ResultsIn 2013, of the 24 ICUs from Canada that participated in the International Nutrition Survey, 8 implemented the PEP uP protocol and the remaining 16 served as concurrent control sites. Patients at PEP uP sites received 60.1% of their prescribed energy requirements from EN compared with 49.9% in patients from control hospitals (P = .02). In addition, patients in PEP uP protocol sites received more protein from EN (61.0% vs 49.7% of prescribed amounts; P = .01), were more likely to receive protein supplements (71.8% vs 47.7%; P = .01), and were more likely to receive >80% of their protein requirements by day 3 (46.1% vs 29.3%; P = .05) compared with patients in control hospitals.ConclusionsIn the real-life setting, the PEP uP protocol can improve the delivery of EN to critically ill patients.© 2014 American Society for Parenteral and Enteral Nutrition.

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