Objective To compare the effects of three reverse trendelenburg position angles on early oxygenation and enteral nutrition tolerance in ARDS patients receiving prone position ventilation. Methods A total of 45 ARDS patients in ICU were randomized into a 0°, 30°, and 45° reverse trendelenburg prone position group, with 14, 16 and 15 cases in each group, and the oxygenation index, gastric residual volume and enteral nutrition-related complications were observed and compared for each group during the 5 days with prone position. Results After 5 days in the prone position, the oxygenation index of the three groups were all improved, and the oxygenation index of the 0° group and the 30° group were significantly higher than that of the 45° group (P＜0.05 for both). On the 4th day of prone position, the gastric residue volume in the 30° group and the 45° group were significantly less than that in the 0° group (P＜0.05 for both).The incidence of reflux in the non-0° group was significantly lower than that in the 0° group (P＜0.05). Conclusion The 30°reverse trendelenburg prone position can effectively improve oxygenation, increase the feeding tolerance, and reduce the incidence of enteral nutrition complications for ARDS patients.