The PEP uP Nutrition Collaborative is designed to foster a network of clinicians committed to the optimal delivery of enteral nutrition therapy in the ICU. The aim of this collaborative is to provide practical tools and strategies to improve the delivery of enteral nutrition, including a volume-based feeding protocol (The PEP uP Protocol), along with additional resources and education of the multidisciplinary team. This initiative will provide practitioners the opportunity to improve current nutrition practices, resulting in better patient outcomes. This initiative will also enable these practitioners to further their role as nutrition educators in the ICU.

What does it mean to 'be involved' in the PEP-uP Collaborative?

To be part of the PEP uP Collaborative and gain access to the PEP uPtools, means that your site MUST be committed to:

  1. implementing the following essential parts of the most updated PEP uP Feeding Protocol which is available on our website PEP UP Toolkit (access to be granted by the Critical Care Nutrition team):
  2. Offer 1 of these 3 feeding options as a pre-printed order form

Stable patients: volume-based feeding OR

Unstable patients: Trophic feeds at 10 ml/hr OR

If contrainidicated: NPO and indicate reason

  1. prophylactic use of motility agents starting on day 1.
  2. using protein supplements starting on day 1 that provide 12g of protein per day.
  3. participating in the International Nutrition Survey[1] to audit your nutrition practices several months after implementing the protocol.

While the use of a 1.5 kcal/ml semi-elemental formula may be better tolerated in the early phase of critical illness, if this is a barrier to you implementing the PEP uP protocol, you may use a polymeric or another type of formula at your own discretion. Also, the critical gastric residual volume you use in your protocol does not have to be 300 ml. Anywhere between 250 to 500 ml will be acceptable to us.

Please note that in order to be part of the PEP UP Collaborative, you MUST contact us to obtain the most recent feeding protocol and associated tools which are password protected.

Please contact Margot Viola at for more information.

What else is expected of a participating site?

As a PEPuPCollaborative site, you are expected to:

Use other tools and resources available on our website (access to be granted by the Critical Care Nutrition team)

Participate in the online discussion group and share your experiences with others in the PEP uP Collaborative. Access to the discussion group is done through our password protected PEP uP tools website.

Involve your bedside nurses and share your experiences with your local administration

We encourage you to visit our website for more details at:

February 21st, 2013

[1] The next International Nutrition Survey (INS) is to be held on May 15th 2013. If your site has implemented the PEP uP protocol by April 2013, you are expected to participate in this survey. If your site is not ready in time, the electronic INS data capture system will be made available for you to access several months after adopting the protocol.