Before–after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position

SummaryBackgrounds & aimsTo evaluate an intervention for improving the delivery of early enteral nutrition (EN) in patients receiving mechanical ventilation with prone positioning (PP).MethodsEligible patients receiving EN and mechanical ventilation in PP were included within 48 h after intubation in a before–after study. Patients were semi-recumbent when supine. Intolerance to EN was defined as residual gastric volume greater than 250 ml/6 h or vomiting. In the before group (n = 34), the EN rate was increased by 500 ml every 24 h up to 2000 ml/24 h; patients were flat when prone and received erythromycin (250 mg IV/6 h) to treat intolerance. In the intervention group (n = 38), the EN rate was increased by 25 ml/h every 6 h to 85 ml/h, 25° head elevation was used in PP, and prophylactic erythromycin was started at the first turn.ResultsCompared to the before group, larger feeding volumes were delivered in the intervention group (median volume per day with PP, 774 ml [IQR 513–925] vs. 1170 ml [IQR 736–1417]; P < 0.001) without increases in residual gastric volume, vomiting, or ventilator-associated pneumonia.ConclusionAn intervention including PP with 25° elevation, an increased acceleration to target rate of EN, and erythromycin improved EN delivery.