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

Clin Nutr. 2010 Apr;29(2):210-6. doi: 10.1016/j.clnu.2009.08.004. Epub 2009 Aug 26.


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 48h after intubation in a before-after study. Patients were semi-recumbent when supine. Intolerance to EN was defined as residual gastric volume greater than 250ml/6h or vomiting. In the before group (n=34), the EN rate was increased by 500ml every 24h up to 2000ml/24h; patients were flat when prone and received erythromycin (250mgIV/6h) to treat intolerance. In the intervention group (n=38), the EN rate was increased by 25ml/h every 6h to 85ml/h, 25 degrees 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, 774ml [IQR 513-925] vs. 1170ml [IQR 736-1417]; P<0.001) without increases in residual gastric volume, vomiting, or ventilator-associated pneumonia.

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

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Clinical Protocols
  • Critical Care / methods*
  • Critical Illness / therapy*
  • Diet
  • Enteral Nutrition / adverse effects
  • Enteral Nutrition / methods*
  • Erythromycin / therapeutic use
  • Female
  • Gastric Emptying
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Patient Positioning
  • Pneumonia, Ventilator-Associated
  • Prone Position
  • Respiration, Artificial / adverse effects
  • Time Factors
  • Vomiting


  • Gastrointestinal Agents
  • Erythromycin