title: Enteral Nutrition in Patients Receiving Mechanical Ventilation in a Prone Position.
abstract: BACKGROUND
  Patients treated with mechanical ventilation in the prone position (PP) could have an increased risk for feeding intolerance. However, the available evidence supporting this hypothesis is limited and contradictory.
  
  
  OBJECTIVE
  To examine the feasibility and efficacy of enteral nutrition (EN) support and its associated complications in patients receiving mechanical ventilation in PP.
  
  
  METHODS
  Prospective observational study including 34 mechanically ventilated intensive care patients who were turned to the prone position over a 3-year period. End points related to efficacy and safety of EN support were studied.
  
  
  RESULTS
  In total, more than 1200 patients were admitted to the intensive care unit over a period of 3 years. Of these, 34 received mechanical ventilation in PP. The mean days under EN were 24.7 ± 12.3. Mean days under EN in the supine position were significantly higher than in PP (21.1 vs 3.6; P < .001), but there were no significant differences in gastric residual volume adjusted per day of EN (126.6 vs 189.2; P = .054) as well as diet volume ratio (94.1% vs 92.8%; P = .21). No significant differences in high gastric residual events per day of EN (0.06 vs 0.09; P = .39), vomiting per day of EN (0.016 vs 0.03; P = .53), or diet regurgitation per day of EN (0 vs 0.04; P = .051) were found.
  
  
  CONCLUSIONS
  EN in critically ill patients with severe hypoxemia receiving mechanical ventilation in PP is feasible, safe, and not associated with an increased risk of gastrointestinal complications. Larger studies are needed to confirm these findings.
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario, Madrid, Spain isaezdelafuente@gmail.com.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Saez de la Fuente
authors.affiliation: Department of Pharmacy, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Saez de la Fuente
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario, Madrid, Spain.
authors.forename: Maria Delicias
authors.initials: MD
authors.lastname: Quintana Estelles
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario, Madrid, Spain.
authors.forename: Renata
authors.initials: R
authors.lastname: Garcia Gigorro
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario, Madrid, Spain.
authors.forename: Luis Juan
authors.initials: LJ
authors.lastname: Terceros Almanza
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario, Madrid, Spain.
authors.forename: Jose Angel
authors.initials: JA
authors.lastname: Sanchez Izquierdo
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitario, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Montejo Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy; D023381:Endpoint Determination; D004750:Enteral Nutrition; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D011446:Prospective Studies; D012121:Respiration, Artificial; D014839:Vomiting
keywords: critical care; enteral nutrition; hypoxemia; mechanical ventilation; prone position; respiratory failure