Nursing issues in enteral nutrition during prone position in critically ill patients: A systematic review of the literature

Bruni, Andrea; Garofalo, Eugenio; Grande, Laura Di; Auletta, Gennaro; Cubello, Davide; Greco, Manfredi; Lombardo, Nicola; Garieri, Pietro; Papaleo, Anna; Doldo, Patrizia; Spagnuolo, Rocco; Longhini, Federico

doi:10.1016/j.iccn.2020.102899

Cited by 27 publications

(35 citation statements)

References 19 publications

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“…A prokinetic agent may also be used in this situation to improve gut motility and tolerance to EN. Experience from the previously conducted studies have served as a good foundation to execute tube feeding in critically ill COVID‐19 patients in prone position as we await further studies specific to our COVID‐19 patients 33–35 . ASPEN recommends following the general guidelines of nutrition for ICU patients in COVID‐19 as well.…”

Section: Prone Positioning In Covid‐19mentioning

confidence: 99%

Challenges of Maintaining Optimal Nutrition Status in COVID‐19 Patients in Intensive Care Settings

Minnelli

Gibbs

Larrivee

et al. 2020

J Parenter Enteral Nutr

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The coronavirus disease 2019 (COVID-19) pandemic has threatened patients, healthcare systems, and all countries across the globe with unprecedented challenges and uncertainties. According to the latest literature, most patients with COVID-19 have mild symptoms that do not require hospital admissions, and only a small percentage of those hospitalized require intensive care. In the intensive care unit (ICU), a registered dietitian nutritionist (RDN) assists the critical care team by formulating, executing, and monitoring the nutrition strategies and interventions to meet the unique requirements of extremely sick patients. However, because of the novelty of COVID-19, the situation is fluid and guidelines continue to be developed and updated. This article discusses the interim guidelines available for the nutrition support of ICU COVID-19 patients and the challenges the critical care team and RDN may face from a nutrition standpoint.

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Section: Prone Positioning In Covid‐19mentioning

confidence: 99%

Challenges of Maintaining Optimal Nutrition Status in COVID‐19 Patients in Intensive Care Settings

Minnelli

Gibbs

Larrivee

et al. 2020

J Parenter Enteral Nutr

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“…Although ESPEN guidelines and studies consider feeding intolerance common in patients in prone positions [ 26 ], feeding patients in prone positions with ARDS is challenging. However, most studies were conducted using small case numbers [ 39 ]. A prospective study that enrolled 34 patients demonstrated that feeding ARDS patients in the prone position did not significantly increase gastrointestinal complications [ 40 ], and the feeding amount could reach 92% of the estimated caloric intake.…”

Section: Discussionmentioning

confidence: 99%

Caloric Intake with High Ratio of Enteral Nutrition Associated with Lower Hospital Mortality for Patients with Acute Respiratory Distress Syndrome Using Prone Position Therapy

Chao

Hsu

et al. 2021

Nutrients

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Positioning patients in the prone position leads to reduced hospital mortality rates for those with severe acute respiratory distress syndrome (ARDS). What constitutes the optimal feeding strategy for prone patients with ARDS is controversial. We conducted a retrospective study that enrolled 110 prone patients with ARDS in two medical intensive care units (ICUs) from September 2015 to November 2018. Inclusion criteria were as follows: age ≥20 years, diagnosis of respiratory failure requiring mechanical ventilation, diagnosis of ARDS within 72 h of ICU admission, placement in a prone position within the first 7 days of ICU admission, and ICU stay of more than 7 days. Exclusion criteria were as follows: nil per os orders because of gastrointestinal bleeding or hemodynamic instability, and ventilator dependency because of chronic respiratory failure. The consecutive daily enteral nutrition(EN)/EN + parenteral nutrition(PN) ratio could predict hospital mortality rates within the first 7 days of admission when using generalized estimating equations (p = 0.013). A higher average EN/EN + PN ratio within the first 7 days predicted (hazard ratio: 0.97, confidence interval: 0.96–0.99) lower hospital mortality rates. To reduce hospital mortality rates, caloric intake with a higher EN ratio may be considered for patients in prone positions with ARDS.

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“…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][34][35]37,40 and 1 trial 36 . Two studies 4,37 evaluated clinical outcomes with no difference in ventilatorassociated pneumonia, length of stay, and mortality between the supine and prone groups.…”

Section: En In Patients In Prone Positionmentioning

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

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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.

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Nursing issues in enteral nutrition during prone position in critically ill patients: A systematic review of the literature

Cited by 27 publications

References 19 publications

Challenges of Maintaining Optimal Nutrition Status in COVID‐19 Patients in Intensive Care Settings

Challenges of Maintaining Optimal Nutrition Status in COVID‐19 Patients in Intensive Care Settings

Caloric Intake with High Ratio of Enteral Nutrition Associated with Lower Hospital Mortality for Patients with Acute Respiratory Distress Syndrome Using Prone Position Therapy

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

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