To feed or not to feed?
By Allison Varnum
Many times, enteral nutrition (EN) is withheld when a patient is in the prone position because of concern of aspiration, gastric intolerance, and other complications related to feeding. However, there are several studies that show EN during prone positioning is not associated with increased risk of gastrointestinal or pulmonary complications and recommend that patients requiring pronation receive early EN.
Malnutrition is common in patients with chronic or critical illnesses and is related to increased hospital length of stay, higher treatment costs, and increased mortality1. Between 38% and 78% of critically ill patients are malnourished and many will further decline over the course of their hospitalization2. Providing EN for these patients is imperative to promote healing3.
The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends that every critically ill patient staying more than 48 hours in the intensive care unit (ICU) should be considered at risk for malnutrition and medical nutrition therapy should be considered for these patients including patients in the prone position4. Postpyloric feeding is appropriate for patients with an increased risk for aspiration only after gastric feeding with the addition of a prokinetic agent to enhance motility is unsuccessful5,6.
According to these standards, patients in the prone position should be provided with nutritional therapy to facilitate wound healing as well as to decrease the length of stay in the hospital, mortality, hospital readmissions, and treatment time. Feeding patients properly will decrease the cost of stay and increase their quality of life1,7.
We at Turn Medical are passionate about providing innovative solutions to help patients and caregivers. For more information about automated prone positioning, visit turnmedical.com or call 855-ASK-TURN.
References
- Norman, K., Prichard, C., Lochs, H., Pirlich, M. (2008). Prognostic impact of disease-related malnutrition. Clinical nutrition, 27(1), 5-15. https://doi.org/10.1016/j.clnu.2007.10.007
- Narayan, S.K., Gudivada, K.K., Krishna, B. (2020). Assessment of nutritional status in the critically ill. Indian journal of critical care medicine, 24(4), 152-156. doi: 10.5005/jp-journals-10071-23617
- Jordan, E.A., Moore, S.C. (2019). Enteral nutrition in critically ill adults: Literature review of protocols. Nursing in critical care, 25(1), 24-30. https://doi.org/10.1111/nicc.12475
- Singer, P., Blaser, A., Berger, M.M., et al. (2023). ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clinical nutrition, 42(2023), 1671-1689. https://doi.org/10.1016/j.clnu.2023.07.011
- McClave, S.A., Taylor, B.E., Martindale, R.G., et al. (2016). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Journal of parenteral and enteral nutrition, 40(2), 159-211. https://doi.org/10.1177/0148607115621863
- Martindale, R., Patel, J.J., Taylor, B., et al. (2020). Nutrition therapy in critically ill patients with coronavirus disease 2019. JPEN. Journal of parental and enteral nutrition, 44(7), 1174-1184. https://doi.org/10.1002/jpen.1930
- Allaudeen, N., Vidyarthi, A., Maselli, J., & Auerbach, A. (2011). Redefining readmission risk factors for general medicine patients. Journal of hospital medicine, 6(2), 54-60. doi: 10.1002/jhm.805
