Abstract
The COVID-19 pandemic introduced a unique patient population requiring a triad of therapies: oxygen, nutrition, and patient positioning support. This study investigates the risk of aspiration pneumonia in COVID-19 patients placed in a prone position while receiving continuous enteral nutrition (EN). The retrospective, single-center study reviewed 97 electronic health records (EHR) of patients admitted between March 15, 2020, and June 1, 2022, at a southwest academic medical center. Patients included were diagnosed with COVID-19, aged 18 or older, and received continuous EN via nasogastric or nasoduodenal tubes while on high-flow oxygen support, excluding those on mechanical ventilation.
The study aimed to identify the rate and risk of aspiration pneumonia in this patient population. Data were extracted from EHRs, including patient demographics, tube feed frequency, patient positioning, and incidence of aspiration pneumonia. Statistical analyses compared patients who developed aspiration pneumonia to those who did not, using chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous measures. Multivariable logistic regression controlled for covariates such as age and gender.
Results showed that 8.2% of patients developed aspiration pneumonia, with a higher incidence in those with post-pyloric feeding tubes. The study found no significant difference in aspiration risk between prone and supine positions, aligning with existing literature. The findings suggest that prone positioning with continuous EN may not increase aspiration pneumonia risk compared to supine positioning, provided that nursing interventions such as head-of-bed elevation and frequent monitoring are implemented.
This study highlights the importance of diligent nursing care in managing COVID-19 patients requiring high-flow oxygen and continuous EN. The results support the potential for practice changes that allow prone positioning with minimal aspiration risk, promoting patient comfort and potentially improving outcomes. Further research with larger sample sizes across multiple centers is recommended to validate these findings and inform clinical guidelines.
Notes
References: Boullata, J. I., et al. (2017). ASPEN safe practices for enteral nutrition therapy. Journal of Parenteral and Enteral Nutrition, 41(1), 15–103. Retrieved October 2023 from https://doi.org/10.1177/0148607116673053
Lewis, K., Algahtani, Z., Mcintyre, L., Almenawer, S., Alshamsi, F., Rhodes, A., Evans, L., Angus, D. C., & Alhazzani, W. (2016). The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: A systematic review and meta-analysis of randomized trials. Critical Care, 20(259), 1-12. https://doi.org/10.1186/s13054-016-1441-z
Martindale, R., Patel, J. J., Taylor, B., Arabi, Y. M., Warren, M., & McClave, S. A. (2020). Nutrition therapy in critically ill patients with coronavirus disease 2019. Journal of parenteral and enteral nutrition, 44(7), 1174–1184. https://doi.org/10.1002/jpen.1930
Mizock B. A. (2007). Risk of aspiration in patients on enteral nutrition: Frequency, relevance, relation to pneumonia, risk factors, and strategies for risk reduction. Current gastroenterology reports, 9(4), 338–344. https://doi.org/10.1007/s11894-007-0039-7
Toussaint, E., Van Gossum, A., Ballarin, A., & Arvanitakis, M. (2015). Enteral access in adults. Clinical Nutrition, 34(3), 350–358. https://doi.org/10.1016/j.clnu.2014.10.009.
Ukleja, A., Gilbert, K., Mogensen, K. M., Walker, R., Ward, C. T., Ybarra, J., Holcombe, B., & Task Force on Standards for Nutrition Support: Adult Hospitalized Patients, the American Society for Parenteral and Enteral Nutrition. (2018). Standards for nutrition support: Adult hospitalized patients. Nutrition in Clinical Practice, 33(6), 906–920. https://doi.org/10.1002/ncp.10204
Sigma Membership
Psi Epsilon
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Acute Care, Interprofessional, Interdisciplinary, Implementation Science, COVID-19, Aspiration Pneumonia Risk Factors
Recommended Citation
LeGal, Michael; Winham, Sari; and Ernst, Jennifer, "Examining Proning Covid-19 Patients with Continuous Enteral Feedings: A Retrospective Study" (2025). International Nursing Research Congress (INRC). 47.
https://www.sigmarepository.org/inrc/2025/presentations_2025/47
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Examining Proning Covid-19 Patients with Continuous Enteral Feedings: A Retrospective Study
Seattle, Washington, USA
The COVID-19 pandemic introduced a unique patient population requiring a triad of therapies: oxygen, nutrition, and patient positioning support. This study investigates the risk of aspiration pneumonia in COVID-19 patients placed in a prone position while receiving continuous enteral nutrition (EN). The retrospective, single-center study reviewed 97 electronic health records (EHR) of patients admitted between March 15, 2020, and June 1, 2022, at a southwest academic medical center. Patients included were diagnosed with COVID-19, aged 18 or older, and received continuous EN via nasogastric or nasoduodenal tubes while on high-flow oxygen support, excluding those on mechanical ventilation.
The study aimed to identify the rate and risk of aspiration pneumonia in this patient population. Data were extracted from EHRs, including patient demographics, tube feed frequency, patient positioning, and incidence of aspiration pneumonia. Statistical analyses compared patients who developed aspiration pneumonia to those who did not, using chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous measures. Multivariable logistic regression controlled for covariates such as age and gender.
Results showed that 8.2% of patients developed aspiration pneumonia, with a higher incidence in those with post-pyloric feeding tubes. The study found no significant difference in aspiration risk between prone and supine positions, aligning with existing literature. The findings suggest that prone positioning with continuous EN may not increase aspiration pneumonia risk compared to supine positioning, provided that nursing interventions such as head-of-bed elevation and frequent monitoring are implemented.
This study highlights the importance of diligent nursing care in managing COVID-19 patients requiring high-flow oxygen and continuous EN. The results support the potential for practice changes that allow prone positioning with minimal aspiration risk, promoting patient comfort and potentially improving outcomes. Further research with larger sample sizes across multiple centers is recommended to validate these findings and inform clinical guidelines.
Description
This study examined the risk of aspiration pneumonia in COVID-19 patients receiving continuous enteral nutrition (EN) in the prone position. Analyzing 97 electronic health records it found an 8.2% incidence of aspiration pneumonia. No significant difference in aspiration risk was observed between prone and supine positions. The results suggest that with appropriate nursing care, prone positioning may be safe, warranting further research to validate these findings and inform clinical practice.