During the prone position, there may be an increase in intragastric pressure. The investigators focus on a scientific question: Whether reducing enteral nutrition before the prone position will benefit patients with severe mechanically ventilated acute respiratory distress syndrome (ARDS).
The experimental group had the enteral nutrition dose reduced before the prone position, while the control group did not have the enteral nutrition dose reduced
Age ≥18 years old
Within 24 hours of admission to the ICU, one or more organ systems have failed (the Sequential Organ Failure Assessment (SOFA) score of any single organ system is ≥2)
Meet the diagnostic criteria for moderate/severe ARDS (even after optimizing the ventilation Settings, the oxygenation index is still < 150mmHg and PEEP is still ≥5 cm H2O)
It is expected to stay in the ICU for more than 48 hours
There are contraindications for the prone position
There are contraindications for EN, preventing the initiation of early EN (≤48 hours)
Expected to die within 48 hours
Pregnancy
Parallel
Enteral nutrition is reduced before the prone position
Procedure/SurgeryBefore the prone position, the gastric contents are aspirated with a syringe, and the dose of enteral nutrition reduction is determined based on the different amounts of gastric residue. If the residual volume in the stomach is less than 200ml, the enteral nutrition intake will be reduced by one third. Gastric residual volume 200-500ml: Reduce enteral nutrition by half. If the residual gastric volume is greater than 500ml: Stop enteral nutrition and consider post-pyloric feeding
The incidence of gastric retention during prone position
The incidence of gastric retention (with a single gastric residual volume \> 200ml) during prone position.
The frequency of gastric retention during the prone position
The number of times of gastric retention (with a single gastric residual volume \> 200ml) per unit time during prone position (times per day)
The incidence of diarrhea during ICU stay
Having three or more loose or liquid stools per day, with a stool weight greater than 200-250g/d (or more than 250ml/d)
EN interruption rate
High gastric residual volume (single dose \> 500ml) or serious gastrointestinal adverse events lead to the need to suspend EN administration
The incidence of Ventilator-associated pneumonia (VAP) among the participants
Pulmonary infectious inflammation that occurs 48 hours after the end of ventilator treatment is a type of hospital-acquired pneumonia
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