TY - JOUR
T1 - Nutrition Support During Prone Positioning
T2 - An Old Technique Reawakened by COVID-19
AU - Behrens, Shay
AU - Kozeniecki, Michelle
AU - Knapp, Nathan
AU - Martindale, Robert G.
N1 - Publisher Copyright:
© 2020 American Society for Parenteral and Enteral Nutrition
PY - 2021/2
Y1 - 2021/2
N2 - Acute respiratory distress syndrome (ARDS) is a complex disease characterized by inflammation, resulting in diffuse alveolar damage, proliferation, and fibrosis, and carries a high mortality rate. Recently, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has overwhelmed healthcare systems worldwide, as many patients have required hospitalization for the management of respiratory failure similar in nature to ARDS. In addition to lung-protective ventilation strategies aimed to maintain an oxygen saturation >90%, a ratio of partial pressure of oxygen to fraction of inspired oxygen >200, a pH of 7.25–7.40, and a plateau pressure <35 cm H2O, prone positioning has emerged as an effective treatment strategy for severe ARDS by improving oxygenation and secretion clearance. Although early nutrition assessment and intervention are recommended for acutely and critically ill patients, rotational therapy may present challenges in providing this care. Here, we will describe the pathophysiology of ARDS and the rationale for use of prone positioning and review the considerations and challenges of providing nutrition therapy for patients in the prone position.
AB - Acute respiratory distress syndrome (ARDS) is a complex disease characterized by inflammation, resulting in diffuse alveolar damage, proliferation, and fibrosis, and carries a high mortality rate. Recently, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has overwhelmed healthcare systems worldwide, as many patients have required hospitalization for the management of respiratory failure similar in nature to ARDS. In addition to lung-protective ventilation strategies aimed to maintain an oxygen saturation >90%, a ratio of partial pressure of oxygen to fraction of inspired oxygen >200, a pH of 7.25–7.40, and a plateau pressure <35 cm H2O, prone positioning has emerged as an effective treatment strategy for severe ARDS by improving oxygenation and secretion clearance. Although early nutrition assessment and intervention are recommended for acutely and critically ill patients, rotational therapy may present challenges in providing this care. Here, we will describe the pathophysiology of ARDS and the rationale for use of prone positioning and review the considerations and challenges of providing nutrition therapy for patients in the prone position.
KW - acute respiratory distress syndrome
KW - coronavirus disease 2019
KW - enteral nutrition
KW - mechanical ventilation
KW - prone position
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U2 - 10.1002/ncp.10592
DO - 10.1002/ncp.10592
M3 - Review article
C2 - 33095474
AN - SCOPUS:85093518853
SN - 0884-5336
VL - 36
SP - 105
EP - 109
JO - Nutrition in Clinical Practice
JF - Nutrition in Clinical Practice
IS - 1
ER -