Is prone positioning recommended in patients with elevated GRVs? Why?

• A. Yes, to reduce aspiration
• B. Yes, to improve tolerance
• C. No, as it may increase the risk of aspiration
• D. No, because it has no effect on aspiration risk

Answer: (C)

Elevated gastric residual volumes signal a higher risk of gastric contents regurgitating and being aspirated during feeding. In the prone position, there is a greater potential for reflux toward the oropharynx and for airway protection to be compromised, making aspiration more likely. Managing feeds and airway becomes more challenging when a patient is prone, so the combination of high GRV and prone positioning increases aspiration risk. Therefore, prone positioning is not recommended in patients with elevated GRVs. If respiratory support is needed, focus first on reducing aspiration risk with strategies like elevating the head of the bed when possible, adjusting feeding regimens, and using prokinetic agents as appropriate, while considering other oxygenation approaches.