Enteral nutrition during prone position in adult critical patient in ICU

The rescue therapies of refractory hypoxemia in ARDS’ patients include unconventional ventilatory strategies and other interventions, such as the prone position. Prone position easies ventilation in dorsal lung areas, improves the ventilation/perfusion ratio, and prevents mostly from Ventilator Induced Lung Injury (VILI). The pronation procedure of ventilated patients can also be performed in presence of highly invasive devices such as continuous renal replacement treatments (CRRT) and extracorporeal membrane oxygenation (ECMO). Pronation is associated, however, to a series of potential risks, including gastric regurgitation and intolerance to enteral nutrition (EN). This paper comments on a recent literature review about the feasibility of the EN administration in ventilated patients in prone position. The results of the four studies included in the review indicate the absence of major complications. Unfortunately significant limitations in studies’ designs, low samples’ size and diversification of management protocols of EN, call for the need of further prospective and well-designed studies to produce adequate evidence supporting the implementation of EN administration in this kind of patients