Related Experiment Video
Updated: Jun 20, 2026

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Before-after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position
Jean Reignier1, Jerome Dimet, Laurent Martin-Lefevre
1Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon, France; Clinical Research Unit, District Hospital Center, La Roche-sur-Yon, France. jean.reignier@chd-vendee.fr
Backgrounds & Aims:
To evaluate an intervention for improving the delivery of early enteral nutrition (EN) in patients receiving mechanical ventilation with prone positioning (PP).
Methods:
Eligible patients receiving EN and mechanical ventilation in PP were included within 48h after intubation in a before-after study. Patients were semi-recumbent when supine. Intolerance to EN was defined as residual gastric volume greater than 250ml/6h or vomiting. In the before group (n=34), the EN rate was increased by 500ml every 24h up to 2000ml/24h; patients were flat when prone and received erythromycin (250mgIV/6h) to treat intolerance. In the intervention group (n=38), the EN rate was increased by 25ml/h every 6h to 85ml/h, 25 degrees head elevation was used in PP, and prophylactic erythromycin was started at the first turn.
Results:
Compared to the before group, larger feeding volumes were delivered in the intervention group (median volume per day with PP, 774ml [IQR 513-925] vs. 1170ml [IQR 736-1417]; P<0.001) without increases in residual gastric volume, vomiting, or ventilator-associated pneumonia.
Conclusion:
An intervention including PP with 25 degrees elevation, an increased acceleration to target rate of EN, and erythromycin improved EN delivery.
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