Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Anesthesiology, Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
JPEN J Parenter Enteral Nutr. 2023 Nov;47(8):1011-1020. doi: 10.1002/jpen.2556. Epub 2023 Aug 30.
Patients who are critically ill frequently accrue substantial nutrition deficits due to multiple episodes of prolonged fasting prior to procedures. Existing literature suggests that, for most patients receiving tube feeding, the aspiration risk is low. Yet, national and international guidelines do not address fasting times for tube feeding, promoting uncertainty regarding optimal preprocedural fasting practice. We aimed to characterize current institutional fasting practices in the United States for patients with and without a secure airway, with variable types of enteral access, for representative surgical procedures.
The survey was distributed to a purposive sample of academic institutions in the United States. Reponses were reported as restrictive (6-8 h preprocedurally) or permissive (<6 h or continued intraprocedurally) feeding policies. Differences between level 1 trauma centers and others, and between burn centers and others, were evaluated.
The response rate was 40.3% (56 of 139 institutions). Responses revealed a wide variability with respect to current practices, with more permissive policies reported in patients with secure airways. In patients with a secure airway, Level 1 trauma centers were significantly more likely to have permissive fasting policies for patients undergoing an extremity incision and drainage for each type of feeding tube surveyed.
Current hospital policies for preprocedural fasting in patients receiving tube feeds are conflicting and are frequently more permissive than guidelines for healthy patients receiving oral nutrition. Prospective research is needed to establish the safety and clinical effects of various fasting practices in tube-fed patients.
由于在手术前多次长时间禁食，重症患者经常会出现严重的营养不足。现有文献表明，对于大多数接受管饲的患者，其吸入风险较低。然而，国家和国际指南并未针对管饲的禁食时间进行说明，这导致了术前禁食实践的最佳方案存在不确定性。我们旨在描述美国目前对有和无安全气道、不同类型肠内营养途径的患者在接受有代表性的手术时的禁食实践。
该调查以美国的学术机构为目标人群进行了针对性抽样。将报告的禁食策略分为限制（术前 6-8 小时）和宽松（<6 小时或术中持续）两种。评估了 1 级创伤中心与其他中心、烧伤中心与其他中心之间的差异。
应答率为 40.3%（139 个机构中的 56 个）。结果显示，目前的实践存在很大的差异，有安全气道的患者的宽松政策更多。对于有安全气道的患者，1 级创伤中心对于接受各种管饲的接受四肢切开引流的患者，其术前禁食宽松政策的可能性明显更高。
目前，接受管饲的患者在术前禁食方面的医院政策相互矛盾，并且比接受口服营养的健康患者的指南更加宽松。需要开展前瞻性研究，以确定各种禁食实践在管饲患者中的安全性和临床效果。
