Nursing issues in enteral nutrition during prone position in critically ill patients: A systematic review of the literature.
Andrea Bruni, Eugenio Garofalo, Laura Grande and 9 others
PMID 32641217WHAT IT FOUND
Prone positioning did not consistently worsen tube-feeding tolerance in ventilated ICU patients; one study found more vomiting and feeding stops.
A 24-hour feeding protocol increased delivered volume without increasing stomach residue.
Key findings
01Six single-centre studies of 241 mechanically ventilated adults found no consistent increase in gastric residual volume during prone position, although one study reported lower feeding volume in prone position.
02In one study, enteral feeding was stopped in 82% of prone-position patients (63 discontinuations) versus 49% of supine-position patients (42 discontinuations).
03Extending enteral nutrition over 24 hours significantly increased daily administered feed volume without any impact on gastric residue.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only six single-centre studies with 241 patients were included, and no pooled analysis was possible. Risk of bias was high or intermediate for all studies, with only one study showing low risk of selection bias. Studies used different designs and different thresholds for high gastric residual volume, from over 150 ml to over 500 ml. Major clinical outcomes were assessed in only two studies by the same group, and the mortality comparison came from a before-after protocol study. The review could not provide data about real-life use of enteral nutrition during prone position.
Declared interests
The authors declared no known competing financial interests or personal relationships.
The easy way to misread this
Do not conclude that prone position is always safe for enteral feeding or that 24-hour feeding improves survival. The review included six low-quality single-centre studies, used different definitions of intolerance, and could not pool the data; the mortality finding came from one before-after comparison.