I am throwing this question out to all PEPuP protocol users. We have recently introduced this protocol into our ICU. I wondered how other institutions deal with vasopressor use. As per the protocol, we start these patients on trophic feeds and usually conservatively titrate these patients up to a goal rate until they are off pressors (depending on clinical judgment), at which point we would assess them for volume based feeding. What we are noticing is patients in our ICU have been on high dose vasopressors for which seems like an extended period of time (even once they are extubated) and that by the time they are coming off the pressors they are ready for extubation. This means that we are missing the opportunity for starting volume based feeds on many patients. I am curious to know how other institutions that use PEPuP deal with these situations and if there is a point they would switch them over to volume based feeds even while they are still on pressors?