| Background:Prone position ventilation(PPV)can reduce the mortality of severe acute respiratory distress syndrome by improving the ventilation / blood flow ratio,improving the uniformity of the lung,strengthening the drainage,and improving the hemodynamics.An American and European official clinical practice guideline(2017)suggests:For patients with severe ARDS,the recommendation is strong for prone positioning for more than 12 h/d.Enteral nutrition(EN),in addition to providing the patient’s daily required heat card,also maintains the integrity of the intestinal function and structure,reduces the incidence of secondary infection,reduces the incidence of organ failure,and shortens the time of hospitalization.The prone position is non a physiological body position.Abdominal compression may increase the intolerance of EN,decrease the intake of EN.Decreaing the EN speed may increase the tolerance of EN during.PPV and high-strenght PPV(duration ≥ 12h/d)may have a certain effect on the intolerance of EN.However,during the past PPV studies,there was relatively little research on EN,and the conclusion was quite different.Objective:To review and analyze the tolerance of EN during PPV in the intensive care unit of the first affiliated hospital of guangzhou medical university during 2013.2-2017.10.The tolerability and intake of EN in patients with prone positioning and non-prone positioning were compared.Methods:1.the own comparison of EN in patients receiving PPV between pre-PPV and PPV:A total of 60 patients receiving invasive mechanical ventilation in the prone position with enteral feeding were studied during 2013.2-2017.10.They were divided into the pre-PPV group and the PPV group before and after each PPV peroid of each patient;they were divided into nasogastric and post-pylorus group by the feeding canal;the nasogastric group was divided into deceleration and non-deceleration group by enteral nutrition speed before PPV;high-strength group was the group that PPV time was more than12 h,according to the time there were ≥ 12 h and ≥ 16 h group.2.the comparison of EN in patients with PPV and without PPV:14 early severe ARDS receiving PPV and 12 early severe ARDS without PPV were included.They were divided as PP(prone position)group and SP(supine position)group.The tolerability and intake of EN in the first week of ICU were compared.Results:1.the own comparison of EN in patients receiving PPV between pre-PPV and PPV:60 ARDS patients underwent 321 peroids of PPV,274 peroids were feeded by nasogastric tube,another 47 were trans-pylorus feeded;When the time of PPV was more than 12 hours,89(72.95%)peroids were in the non-deceleration group,another group had 77peroids(50.66%).When the time of PPV was more than 16 hours,they were 63(51.64%)and 65(42.76%)peroids.There were no significant differences in GRV,vomiting or diet regurgitation between pre-PPV and PPV group(p>0.05),whether or not slow the rate of enteral nutrition by nasogastric tube.The same results were found when the prone time is no less than 12 h.There ware no significant differences in vomiting or diet regurgitation in gastric and post-pyloric canal,but calorie intake by post-pyloric canal was higher.2.the comparison of EN in patients with PPV and without PPV: There were no significant differences in age,oxygenation index,APACHE II score,SOFA score and NUTRIC score between the two groups.There was also no significant difference of EN intolerance between the two groups,but the permissive underfeeding of EN in PP group was later than the SP group.Conclusion:PPV does not increase the risk of gastric retention and EN reflux.Do not slow down the rate of enteral nutrition during PPV.For patients with gastric retention or non-standard enteral nutrition,transpylorus feeding may be the choice. |
PDF Full Text Request