Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

Raymond Dominic Savio; Rajalakshmi Parasuraman; Daphnee Lovesly; Bhuvaneshwari Shankar; Lakshmi Ranganathan; Nagarajan Ramakrishnan; Ramesh Venkataraman

doi:10.1177/1751143719900100

Feasibility, tolerance and effectiveness of enteral feeding in critically ill patients in prone position

J Intensive Care Soc. 2021 Feb;22(1):41-46. doi: 10.1177/1751143719900100. Epub 2020 Jan 14.

Authors

Raymond Dominic Savio¹, Rajalakshmi Parasuraman², Daphnee Lovesly², Bhuvaneshwari Shankar², Lakshmi Ranganathan¹, Nagarajan Ramakrishnan¹, Ramesh Venkataraman¹

Affiliations

¹ Department of Critical Care Medicine, Apollo Hospitals, Chennai, India.
² Department of Dietetics, Apollo Hospitals, Chennai, India.

Abstract

Aim: To assess the feasibility, tolerance and effectiveness of enteral nutrition in critically ill patients receiving invasive mechanical ventilation in the prone position for severe Acute Respiratory Distress Syndrome (ARDS).

Methods: Prospective observational study conducted in a multidisciplinary critical care unit of a tertiary care hospital from January 2013 until July 2015. All patients with ARDS who received invasive mechanical ventilation in prone position during the study period were included. Patients' demographics, severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE II) score), baseline markers of nutritional status (subjective global assessment (SGA) and body mass index), details of nutrition delivery during prone and supine hours and outcomes (Length of stay and discharge status) were recorded.

Results: Fifty-one patients met inclusion criteria out of whom four patients were excluded from analysis since they did not receive any enteral nutrition due to severe hemodynamic instability. The mean age of patients was 46.4 ± 12.9 years, with male:female ratio of 7:3. On admission, SGA revealed moderate malnutrition in 51% of patients and the mean APACHE II score was 26.8 ± 9.2. The average duration of prone ventilation per patient was 60.2 ± 30.7 h. All patients received continuous nasogastric/orogastric feeds. The mean calories (kcal/kg/day) and protein (g/kg/day) prescribed in the supine position were 24.5 ± 3.8 and 1.1 ± 0.2 while the mean calories and protein prescribed in prone position were 23.5 ± 3.6 and 1.1 ± 0.2, respectively. Percentage of prescribed calories received by patients in supine position was similar to that in prone position (83.2% vs. 79.6%; P = 0.12). Patients received a higher percentage of prescribed protein in supine compared to prone position (80.8% vs. 75%, P = 0.02). The proportion of patients who received at least 75% of the caloric and protein goals was 37 (78.7%) and 37 (78.7%) in supine and 32 (68.1%) and 21 (44.6%) in prone position.

Conclusion: In critically ill patients receiving invasive mechanical ventilation in the prone position, enteral nutrition with nasogastric/orogastric feeding is feasible and well tolerated. Nutritional delivery of calories and proteins in prone position is comparable to that in supine position.

Keywords: ARDS; calorie goal; feed intolerance; nutrition; prone ventilation.