Interruption of enteral tube feeding during chest physiotherapy in critically ill adults: A scoping review

TL;DR

This review finds no strong evidence to support stopping enteral feeding during chest physiotherapy in ventilated critically ill adults.

Contribution

The study identifies a lack of empirical evidence for current clinical recommendations on enteral feeding interruption during chest physiotherapy.

Findings

Four studies were identified, but none provided evidence on the safety of interrupting or continuing enteral feeding during chest physiotherapy.

Current guidelines recommend stopping feeding 30 minutes before bronchial drainage, but this is not empirically supported.

There is a need for future studies to investigate the safety and management of enteral feeding during these procedures.

Abstract

Numerous reports indicate that the nutritional targets of critically ill patients are frequently not met. In daily clinical practice, it is often recommended to temporarily stop enteral tube feeding in patients on mechanical ventilation (MV) who are undergoing chest physiotherapy. This is because adverse events can occur and potentially cause vomiting and increase the risk of aspiration pneumonia.

To identify, characterise, and analyse the available evidence on the interruption of enteral tube feeding in critically ill adult patients receiving MV before or during chest physiotherapy.

We conducted a scoping review following the recommendations of the Joanna Briggs Institute. We conducted a systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL (Cochrane Library), CINAHL (EBSCOhost), and other search resources until March 2025. We included studies of any design that addressed the application of chest physiotherapy in adults on MV and receiving enteral tube nutrition. Study selection and data extraction were performed in duplicate, and disagreements were resolved by consensus.

We include four studies that were published between 2018 and 2024. One observational study reported that enteral tube feeding was discontinued due to the application of chest physiotherapy in patients in prone and supine MV. In the other three studies, which contribute to a clinical practice guideline, discontinuation of enteral tube feeding is recommended 30 minutes before using the head-down position as a bronchial drainage manoeuvre. However, no studies report on the safety of chest physiotherapy when enteral tube feeding is either discontinued or continued.

There is no empirical evidence to justify routinely stopping enteral tube feeding during chest physiotherapy in MV patients. Future primary studies should report on the management of enteral tube feeding before or during chest physiotherapy interventions, as well as document any adverse events that may occur during its application.

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