| Background:Prone position ventilation is an effective method to improve oxygenation in patients with hypoxemia.Enteral nutrition is the first choice of nutritional support for critically ill patients,which is of great significance for maintaining the integrity of the gastrointestinal tract,improving the body’s immunity and reducing related complications.However,the increased pressure in the abdominal cavity in the prone position,the use of analgesic and sedative drugs or muscle relaxants,which inhibit gastrointestinal peristalsis,can increase the risk of gastric retention,vomiting or reflux and other enteral nutrition intolerance.At present,there have been inconsistent studies on whether enteral nutrition support in patients with prone position ventilation reduces enteral nutrition tolerance.Therefore,the safety and effectiveness of enteral nutrition support during prone ventilation has been questioned in clinical practice,although clinical nutrition guidelines which strongly suggested that enteral nutrition should be given as soon as possible in patients with prone position ventilation.Objective:To systematically review the safety and effectiveness of enteral nutrition in patients with mechanical ventilation in prone position,and to provide evidence for clinical practice.Methods:We searched the Cochrane Library,PubMed,EMBASE,web of science,clinical trials.gov,well as Chinese literature databases such as CNKI,Wanfang medical network,Chinese biomedical literature database and VIP journal database.Clinical randomized controlled trial,quasi-experimental studies,and cohort studies of patients with enteral nutrition in prone position ventilation were collected,At the same time,through reading references for supplementary retrieval.The language limit is Chinese and English.The retrieval period is from the establishment of the database to January 31,2021.The index words included Prone positioning,Prone position ventilation,Prone ventilation,PPV,Enteral nutrition,Enteric feeding,Total enteral nutrition,EN,Randomized controlled trials,Quasi-randomised trials,Cohort study etc.According to the inclusion and exclusion criteria,two researchers independently screened,evaluated and extracted the retrieved literatures.The data were analyzed by Revman 5.4.Results:Finally,7 English and 3 Chinese literatures were included in the study,including 484 patients.The study group was given enteral nutrition in prone position,while the control group was given enteral nutrition in supine position.Results of the Meta-analysis showed that compared to the control group,the incidence of high gastric residual volume(RR=1.10,95%CI:0.87 to 1.39,P=0.42),the incidence of vomiting or reflux(RR=1.15,95%CI:0.89 to 1.48,P=0.29),ventilator associated pneumonia(RR=1.18,95%CI:0.77 to 1.81,P=0.44)and enteral nutrition interruption(RR=1.42,95%CI:0.90 to 2.24,P=0.13),length of stay in ICU(MD=-0.63,95%CI:-5.94 to 4.68,P=0.82),Daily feeding amount and nutrient intake,showed no statistically significant difference in the availability of enteral nutrition.Conclusions:This study shows that enteral nutrition support during the prone position in critically ill patients does not increase the risk of enteral nutrition feeding intolerance or reduce the effectiveness of enteral nutrition in patients compared to supine.It is suggested that in clinical practice,enteral nutrition support should be provided to patients as early as possible in accordance with the guidelines after adequate evaluation of their gastrointestinal function.However,The quality of those studies included in this study is limited,and high-quality studies are needed for further to verify this conclusion in the future. |
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