Evidence remains limited regarding the optimal enteral nutrition (EN) route for acute respiratory distress syndrome (ARDS) patients undergoing prone positioning. This study aimed to explore the association of post-pyloric feeding with feeding intolerance (FI), specifically in that population.

This single-center retrospective study included adult patients with ARDS who received prone position ventilation at Zhongda Hospital, Southeast University, between July 30, 2016, and April 30, 2024. The primary outcome was the incidence of FI, defined as the failure to achieve an enteral energy intake of 17.5 kcal/kg/day within 72 hours of initiating EN. The statistical approaches utilized included multivariate regression, inverse probability weighting model, and marginal structural cox model to ensure the robustness of our findings. Subgroup analyses were also performed.

Inclusion Criteria:

1. age ≥ 18 years old
2. ARDS, defined by the Berlin standard
3. patients receiving prone position ventilation treatment

Exclusion Criteria:

1. No enteral nutrition within 4 days after initiation of invasive mechanical ventilation
2. Duration of invasive mechanical ventilation <72 hours after initiation of enteral nutrition
3. Prone positioning initiated >3 days after EN
4. Duration of each prone session <12 hours
5. Severe acute pancreatitis
6. Contraindications to early enteral nutrition

intensive care unit