Andrea Bruni1, Eugenio Garofalo1, Laura Grande2, Gaetano Auletta3, Davide Cubello1, Manfredi Greco4, Nicola Lombardo5, Pietro Garieri6, Anna Papaleo7, Patrizia Doldo8, Rocco Spagnuolo9, Federico Longhini10. 1. Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy. 2. Surgery Unit, "Santa Rita" Clinic, Vercelli, Italy. 3. School of Nursing, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy. 4. Plastic Surgery Unit, Department of Clinical and Experimental Medicine, "Magna Graecia" University, Catanzaro, Italy. 5. Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy. 6. Department of Biomedical Sciences for Health, University of Milan, Italy. 7. Department of Anaesthesia and Intensive Care, IRCCS Ca' Granda Maggiore Hospital, Milan, Italy. 8. School of Nursing, Department of Clinical and Experimental Medicine, "Magna Graecia" University, Catanzaro, Italy. 9. Department of Clinical and Experimental Medicine, "Magna Graecia" University, Catanzaro, Italy. 10. Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy. Electronic address: longhini.federico@gmail.com.
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).
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).