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. 2020 Oct:60:102899.
doi: 10.1016/j.iccn.2020.102899. Epub 2020 Jul 5.

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

Andrea Bruni  1 , Eugenio Garofalo  1 , Laura Grande  2 , Gaetano Auletta  3 , Davide Cubello  1 , Manfredi Greco  4 , Nicola Lombardo  5 , Pietro Garieri  6 , Anna Papaleo  7 , Patrizia Doldo  8 , Rocco Spagnuolo  9 , Federico Longhini  10
Affiliations

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

Andrea Bruni et al. Intensive Crit Care Nurs. 2020 Oct.

Abstract

Background: Early enteral nutrition (EN) and prone position may both improve the outcome of patients affected by moderate to severe Acute Respiratory Distress Syndrome. Recent guidelines suggest to administer early EN also during prone position. However, EN intolerance, such as high residual gastric volumes, regurgitation or vomiting, may occur during pronation.

Aim: This systematic review aims to assess the occurrence of high residual gastric volume, regurgitation or vomiting episodes, that can be encountered in patients receiving EN during prone position.

Methods: We have conducted a systematic review. We queried three scientific databases (MEDLINE, EMBASE and CINAHL) from inception until November 19, 2019 without language restrictions, using keywords and related MeSH terms. All relevant articles enrolling adult patients receiving invasive mechanical ventilation and evaluating the use of early EN during prone position were included.

Results: From 111 records obtained, we included six studies. All studies but one reported no differences with respect to gastric residual volumes between supine and prone positions. A 24-hours EN administration protocol seems to be better, as compared to an 18-hours feeding protocol. The need to stop EN and vomiting episodes were higher during prone position, although the rate of high gastric volume was similar between supine and prone positions. Ventilator associated pneumonia, lengths of stay and mortalities were similar between supine and prone positions. Only one study reported lower mortality in patients receiving EN throughout the entire day, as compared to an 18-hours administration protocol.

Conclusion: Protocols should be followed by healthcare providers in order to increase the enteral feeding volume, while avoiding EN intolerance (such as EN stops, high residual volume, regurgitation and vomiting).

Keywords: Enteral nutrition; Nurse; Prone position; Regurgitation; Residual gastric volume; Vomiting.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow Diagram. Flow diagram of studies screening and selection according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) recommendations.
Fig. 2
Fig. 2
Risk of bias assessment. The risk of bias has been assessed for all included studies. All studies suffer of a high (red) or intermediate (white) risk for considered biases. One only study shows a low (green) risk of selection bias. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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