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Meeting protein needs for the mechanically ventilated patient.

The COVID-19 virus has brought new challenges to the nutritional support of the estimated 960,000 patients who will require mechanical ventilation(1). Many ventilated patients will be sedated using a lipid (fat) based medication (diprivan/propofol) that often delivers >400-500 fat calorie per day.

Most enteral tube feeding formulas are not able to deliver enough protein to meet the American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines of 1.2 -2.0 grams of protein per kilogram of actual body weight per day without over feeding calories(2).

For example, a 150 lb. woman’s estimated energy needs would be ~1020-1360 calories (15-20 kcal/ kg) and 65-86 grams of protein (1.5-2.0 gm/ kg) per day. A standard enteral formula would provide the necessary calories but the patient would only receive 43-57 grams of protein from the prescribed feeding formula.  Leaving a deficit of 22-29 additional grams of protein that need to be provided.  In this challenging setting protein provision falls short of the estimated needs. With the additional calories  provided by lipid-based sedatives, closing the the protein gap would be even greater.

Modular protein supplementation must be included in their intervention to meet the protein goals.

The three types of products available for this are:
1. Protein powders only contain 6 grams of protein per packet and must be mixed with 120 mL (3 fl. oz.) of water for administration making it virtually impossible to meet protein requirements due to the amount of water required for dilution. In addition, mixing takes valuable nursing time, risks cross contamination and increases the potential of clogging a feeding tube if the powder is not completely dissolved. These are all well known disadvantages to using powdered proteins and are the major reason protein goals are NOT met with powdered products.

2. Another option is liquid protein that has been made for oral application not tube feeding.  These products are low-quality proteins, contain artificial colors, glycerin which promotes tube fed diarrhea and are thick and sticky so they must be diluted with water, again taking valuable nursing time and risking cross contamination. Because of dilution and high osmolality from the glycerin it is impossible to safely administer multiple packets at one time.

3. Our product, ProSourceTF® is the only liquid protein made specifically for enteral tube feeding. It is water thin and requires no mixing or dilution reducing the risk of cross contamination and nursing time. It is a high-quality fortified liquid protein that meets the Institute of Medicine’s amino acid profile for the high-quality protein with a Protein Digestibility Corrected Amino Acid Score (PDCAAS) of 100. With 11 grams of protein per 45 mL packets, 33 grams of protein can be syringed down the feeding tube in minutes. It has no sweeteners, artificial colors or glycerin and is extremely well tolerated.  ProSourceTF is used by leading hospitals and Level 1 trauma centers worldwide.

The first of ASPEN’s guiding principles for SARS-CoV2 Management(3) is cluster care meaning all attempts are made to bundle care as quickly as possible to limit exposure.  ProSourceTF helps meet this goal by eliminating mixing and dilution as well as the ability to safely administer multiple packets* at one time. It helps nursing perform the task quickly and efficiently.

ProSource TF helps bridge the protein gap, creating a safe, simplified solution for meeting protein needs in the critical care setting.

References/ Resources:
1. Halpern , N., and Kay See Tan. “Society of Critical Care Medicine.” Society of Critical Care Medicine, 19 Mar. 2020, https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19.
2. Mcclave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., Compher, C. (2016). Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition,40(2), 159-211. doi:10.1177/0148607115621863
3. Nutrition Therapy in the Patient with COVID-19 Disease Requiring ICU Care (Reviewed and Approved by ASPEN and Society for Critical-Care Medicine)

*ProSource TF can be administered in multi packet doses.  We recommend administering no more than 3 packets at one time.

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