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

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• 作者：Jean Reignier ; Jerome Dimet ; Laurent Martin-Lefevre ; Frederic Bontemps ; Maud Fiancette ; Eva Clementi ; Christine Lebert ; Benoit Renard
• 关键词：Prone position ; Nosocomial pneumonia ; Enteral nutrition ; Mechanical ventilation ; Gastric emptying ; Critically ill
• 刊名：Clinical Nutrition
• 出版年：2010
• 出版时间：April 2010
• 年：2010
• 卷：29
• 期：2
• 页码：210-216
• 全文大小：460 K

文摘

Summary

Backgrounds & aims

To evaluate an intervention for improving the delivery of early enteral nutrition (EN) in patients receiving mechanical ventilation with prone positioning (PP).

Methods

Eligible 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.

Results

Compared 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.

Conclusion

An intervention including PP with 25° elevation, an increased acceleration to target rate of EN, and erythromycin improved EN delivery.