Landais Mickael, Ehrmann Stephan, Guitton Christophe
Service de réanimation médico-chirurgicale polyvantre centre hospitalier Le Mans.
Service de médecine intensive et réanimation, INSERM CIC 1415, CRCS-TriggerSEP F-CRIN research network, Centre hospitalier régional et universitaire Tours, and Centre d'étude des pathologies respiratoires (CEPR), INSERM U1100, Université de Tours, Tours.
Curr Opin Clin Nutr Metab Care. 2025 Mar 1;28(2):129-133. doi: 10.1097/MCO.0000000000001105. Epub 2025 Jan 16.
The objective of this review is to examine the available evidence concerning feeding interruptions before extubation and other medical procedures in ICUs. We will analyze the physiological mechanisms involved, the potential risks associated with feeding interruptions, as well as the results of recent clinical studies. Additionally, we will explore current practices and recommendations from major professional societies, as well as recent innovations aimed at minimizing feeding interruptions.
Fasting before extubation is a common yet heterogeneous practice, varying across ICUs. Although dysphagia is a frequent complication after extubation, its prevalence decreases over time. However, physiologically, fasting before extubation appears ineffective in reducing gastric content or preventing aspiration. The Ambroisie study demonstrated that continuing enteral nutrition up to extubation is not inferior to a 6 h fasting strategy in terms of extubation failure at 7 days. The management of perioperative nutrition in intubated patients is debated. A retrospective study found no significant difference in postoperative respiratory events between patients fasting for at least 6 h and those fasting less or not at all but further prospective randomized studies are needed for definitive conclusions. For abdominal and digestive surgeries, fasting remains necessary to simplify procedures and reduce contamination risks. For invasive ICU procedures, such as catheter placement, the continuation of enteral nutrition appears reasonable. However, for percutaneous tracheotomy, limited evidence suggests no clear benefit from fasting, though the risk of large-volume aspiration during the procedure raises concerns. The approach to nutrition in this context requires further investigation.
Fasting before extubation in ICUs is a common practice inherited from anesthesia, aiming to reduce the risk of aspiration. The Ambroisie study demonstrates that continuing enteral nutrition until extubation is not inferior to a 6 h fasting strategy regarding extubation failure at 7 days.
本综述旨在研究关于重症监护病房（ICU）拔管前及其他医疗操作期间喂养中断的现有证据。我们将分析其中涉及的生理机制、与喂养中断相关的潜在风险以及近期临床研究的结果。此外，我们还将探讨主要专业学会的当前做法和建议，以及旨在尽量减少喂养中断的近期创新措施。
拔管前禁食是一种常见但存在差异的做法，不同ICU之间有所不同。尽管吞咽困难是拔管后常见的并发症，但其发生率会随时间下降。然而，从生理角度来看，拔管前禁食在减少胃内容物或预防误吸方面似乎并无效果。安布罗西（Ambroisie）研究表明，在7天拔管失败率方面，直至拔管时持续肠内营养并不劣于6小时禁食策略。对于插管患者围手术期营养的管理存在争议。一项回顾性研究发现，禁食至少6小时的患者与禁食时间较短或完全不禁食的患者在术后呼吸事件方面无显著差异，但需要进一步的前瞻性随机研究才能得出明确结论。对于腹部和消化系统手术，禁食对于简化手术过程和降低污染风险仍然是必要的。对于ICU的侵入性操作，如放置导管，继续肠内营养似乎是合理的。然而，对于经皮气管切开术，有限的证据表明禁食并无明显益处，尽管手术期间大量误吸的风险令人担忧。在这种情况下的营养方法需要进一步研究。
ICU拔管前禁食是从麻醉学沿袭而来的常见做法，旨在降低误吸风险。安布罗西研究表明，在7天拔管失败率方面，直至拔管时持续肠内营养并不劣于6小时禁食策略。
