Administration of enteral nutrition in the prone position, gastric residual volume
            and other clinical outcomes in critically ill patients: a systematic review

Machado, Letiane de Souza; Rizzi, Paula; Silva, Flávia Moraes

doi:10.5935/0103-507x.20200019

Cited by 15 publications

(13 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The use of a protocol based on the elevation of the patient’s head, the use of fixed prokinetics and reduced speed of the diet allowed the application of early EN and faster attainment of the planned energy target in prone position, this was found by Regnier et al (2009) [ 50 ]. However, the literature regarding the effect of EN while in the prone position is also sparse and of limited quality [ 51 ]. No studies on agitated patients, whose position can change continuously, have been found.…”

Section: Resultsmentioning

confidence: 99%

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

et al. 2020

View full text Add to dashboard Cite

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

show abstract

Section: Resultsmentioning

confidence: 99%

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Data on efficacy of EN during prone positioning are scarce 38 . A recent systemic review 39 of MEDLINE, Embase, and CINAHL databases from inception until November 2019 that evaluated early EN during the prone positioning of intubated patients found 6 studies, 5 observational cohorts, 4,33–35,37,40 and 1 trial 36 .…”

Section: Methodsmentioning

confidence: 99%

Enteral Nutrition Safety With Advanced Treatments: Extracorporeal Membrane Oxygenation, Prone Positioning, and Infusion of Neuromuscular Blockers

Al‐Dorzi

Arabi

2020

Nut in Clin Prac

View full text Add to dashboard Cite

This review aims at assessing the safety and efficacy of enteral nutrition in critically ill patients receiving extracorporeal membrane oxygenation, prone positioning, and infusion of neuromuscular blockers. Existing data from randomized controlled trials demonstrate the survival benefit of early enteral nutrition in critically ill patients. Observational data have demonstrated that enteral nutrition in patients receiving extracorporeal membrane oxygenation, prone positioning, and infusion of neuromuscular blockers is generally safe. However, these patients are at increased risk for gastrointestinal complications from enteral nutrition because of critical illness–induced gastrointestinal dysfunction; associated shock; the concomitant use of vasopressor agents, sedatives, and narcotics; possibly mesenteric circulatory compromise; and regurgitation associated with prone positioning. Therefore, early enteral nutrition is generally recommended in these patients in the absence of severe gastrointestinal dysfunction or shock. To reduce the complications, early nutrition should be advanced gradually (trophic feeding or permissive underfeeding), the bed should be tilted to a maximum of 30°, and concentrated nutritional formulae and the use of prokinetics may be considered to treat enteral feeding intolerance. Physicians should be vigilant about monitoring for early signs of acute mesenteric ischemia, which should lead to holding enteral feeding. Parenteral nutrition may be utilized in patients who cannot receive enteral nutrition or are unable to reach their nutrition goals by the end of the first week.

show abstract

“…66 Although there are no specific recommendations, current literature suggests center specific protocols which use established clinical techniques proven to decrease the risk of aspiration. 64 This includes elevation of the head of the bed, use of calorie dense feeding to decrease the volume of feeds, continuous feeding, and use of prokinetic agents such as erythromycin to aid gastric emptying. 64…”

Section: Enteral Feeding and Aspiration Riskmentioning

confidence: 99%

“…64 This includes elevation of the head of the bed, use of calorie dense feeding to decrease the volume of feeds, continuous feeding, and use of prokinetic agents such as erythromycin to aid gastric emptying. 64…”

Section: Enteral Feeding and Aspiration Riskmentioning

confidence: 99%

A Quick Review on the Multisystem Effects of Prone Position in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19

Adeola

Patel

Gone

et al. 2021

Clin Med Insights Circ Respir Pulm Med

View full text Add to dashboard Cite

Objective: The purpose of this review is to highlight the multisystem effects of prone position in ARDS patients with a focus on current findings regarding its use in COVID-19 patients. Methods: Two reviewers comprehensively searched PubMed database for literature regarding pathophysiology and efficacy of prone position in ARDS patients as well as specific data regarding this approach in COVID-19 patients. Conclusion: Prone positioning is well-documented to improve oxygenation and cardiac function in ARDS patients and might confer increased survival, with benefits that outweigh risks such as facial edema, endotracheal tube displacement, and intraabdominal organ dysfunction in obese patients. Severe COVID-19 pneumonia, while meeting ARDS criteria, differs from typical ARDS in several ways. Data would suggest that advantages of prone position would become limited after significant disease progression and fibrosis. The use of this technique in COVID-19 requires prolonged sessions that are unprecedented in the treatment of ARDS patients. New data regarding COVID-19 pathophysiology and patients continues to evolve daily. More frequently, patients are proned while maintaining spontaneous breathing—the results of this intervention are an area for future studies. There is more to learn about the appropriate use of prone position in COVID-19 patients. The multisystem risks and benefits require clinicians to adopt a patient centered decision-making algorithm when employing this technique in COVID-19 patients. Level of evidence: NA

show abstract

Administration of enteral nutrition in the prone position, gastric residual volume and other clinical outcomes in critically ill patients: a systematic review

Cited by 15 publications

References 26 publications

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Enteral Nutrition Safety With Advanced Treatments: Extracorporeal Membrane Oxygenation, Prone Positioning, and Infusion of Neuromuscular Blockers

A Quick Review on the Multisystem Effects of Prone Position in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19

Contact Info

Product

Resources

About