Patricia Louzon, BCCCP, PharmD, FCCM
AdventHealth Orlando
Orlando, Florida
Disclosure information not submitted.
Otsanya Ochogbu, BCCCP, PharmD, RPh
AdventHealth Critical Care at Central Florida
Orlando, Florida, United States
Disclosure information not submitted.
Claire Marie Fassett, MS, RDN/LDN
Registered Dietician
AdventHealth Orlando, United States
Disclosure information not submitted.
Shawn Moore, MD
Surgery Resident
AdventHealth Orlando, United States
Disclosure information not submitted.
Rebecca Falter, PharmD
Pharmacist
AdventHealth Orlando, United States
Disclosure information not submitted.
Fahd Ali, MD, FACS
Department of Surgery
AdventHealth Orlando, United States
Disclosure information not submitted.
Title: Toleration of enteral nutrition during prone therapy in a COVID-19 cohort
Introduction: Prone positioning is frequently utilized for acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19). There is sometimes clinician concern for decreased tolerance, vomiting or aspiration associated with enteral nutrition (EN) in prone position (PP), though this has not demonstrated in limited available data, and there is no available evidence in the COVID-19 population. This report was conducted to describe experience with delivering EN in PP patients with ARDS due to COVID-19.
Methods: This study was determined IRB exempt quality improvement. We included all mechanically ventilated patients diagnosed with COVID-19 undergoing PP therapy during 3/17-4/11/2020 who received EN while in PP. The primary objectives were to describe percent of goal feeding rate met and incidence of tube feed intolerance during PP. Secondary objectives were to compare outcomes based on prone vs. supine position and feeding tube (FT) position (gastric or post-pyloric)
Results: 28 patients who underwent a total of 149 prone cycles were included in this descriptive analysis. The most common tube type was a small bore nasogastric tube, and most common placement was gastric. Paralytics were utilized in 93% of patients. During prone therapy, 21% of the patients received only trophic feeds, and 21% received >80% of their target EN goal. The median [IQR] gastric residual volume (GRV) recorded was 150 [7-429] mL, with higher GRV noted in PP compared to supine position [88mL vs 0mL] and 52% of all residuals occurring during PP. There were 3 patients (10.7%) with 4 noted occurrences of GRV > 500mL, all while in PP. The median EN rate administered during PP was equal when compared between gastric and post-pyloric FT (29 mL/hr) with similar proportion of target enteral feed rate achieved during prone therapies in both gastric and post-pyloric FT (54.8% vs. 47.4%). Vomiting and aspiration each occurred in 2 patients (7.1%), equally between prone and supine, with all cases during gastric placement. Eight patients (28.6%) had instances of tube dislodgement, which occurred at all proning cycle phases.
Conclusions: Mechanically ventilated COVID-19 patients with severe ARDS undergoing prone therapy can be fed via the enteral route, with minimal reported adverse events regardless of the route utilized.