Nutrition Support During Prone Positioning: An Old Technique Reawakened by COVID-19

Shay Behrens, Michelle Kozeniecki, Nathan Knapp, Robert G. Martindale

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalNutrition in Clinical Practice
DOIs
StateAccepted/In press - 2020

Keywords

  • acute respiratory distress syndrome
  • coronavirus disease 2019
  • enteral nutrition
  • mechanical ventilation
  • prone position

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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