Peterson Brendan, Nowacki Amy S, Ulintz Alexander, Mace Sharon E
Ohio State University, School of Pharmacy, Columbus, Ohio.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
West J Emerg Med. 2025 Mar;26(2):200-209. doi: 10.5811/westjem.18561.
Procedural sedation (PS) is commonly performed in the emergency department (ED). Nil per os (nothing by mouth) (NPO) guidelines extrapolated from standards for patients undergoing elective procedures in the operating room have been applied to ED PS patients. There has been no large study of ED PS patients comparing differences in adverse events and PS success rates based on NPO status.
From a cohort of consecutive ED PS patients of all ages in the 20 EDs of one hospital system-one quaternary ED, four tertiary EDs, six community hospital EDs, one rural ED, two pediatric EDs, and six freestanding EDs in two states in the Midwest and South-we conducted a retrospective analysis on a prospective database over 183 months from April 2000-June 2015. Primary outcome was the incidence of side effects and complications, which comprised the adverse effects. The side effects were nausea, vomiting, itching/rash, emergence reaction, myoclonus, paradoxical reaction, cough, and hiccups. Complications were oxygen desaturation <90%, respiratory depression (respiratory rate <8), apnea, tachypnea, hypotension, hypertension, bradycardia, and tachycardia. Normal vital signs were age dependent. Secondary outcome was successful sedation defined as completion of the procedure. We examined the association between adverse events and successful sedation with NPO status.
Of 3,274 visits, exact NPO status was known in 2,643 visits. Comparison of NPO <8 hours in 1,388 patients vs ≥ 8 hours in 1,255 patients revealed side effects 5.5% vs 4.5% ( = 0.28); complications 11.9% vs 17.7% ( < 0.001); adverse events 16.3% vs 21.5% ( < 0.001), interventions 4.1% vs 4.4% ( = 0.73), and procedural completions 94.3% vs 89.7% ( < 0.001). After adjustment for age, sex, transfer status, American Society of Anesthesiology physical status classification, race, primary sedative, multiple sedatives, sedative plus analgesic, and primary analgesic, we found no association between NPO status and side effects ( = 0.68), complications ( = 0.48), or adverse effects ( = 0.26); however, procedural completion rate remained significantly higher for NPO < 8 hours ( = 0.007).
A nil per os status ≥8 hours may have similar or worse outcomes than NPO <8 hours, which is contrary to many suggested guidelines. Strict adherence to NPO guidelines in ED procedural sedation patients may not be necessary.
急诊镇静（PS）在急诊科（ED）中较为常见。从手术室择期手术患者标准推断出的禁食（Nil per os，NPO）指南已应用于急诊PS患者。目前尚无大型研究比较急诊PS患者基于禁食状态的不良事件差异和PS成功率。
在一个医院系统的20个急诊科（一个四级急诊科、四个三级急诊科、六个社区医院急诊科、一个农村急诊科、两个儿科急诊科以及中西部和南部两个州的六个独立急诊科）对所有年龄段的连续急诊PS患者队列进行研究，我们在2000年4月至2015年6月的183个月期间对前瞻性数据库进行了回顾性分析。主要结局是副作用和并发症的发生率，其构成了不良事件。副作用包括恶心、呕吐、瘙痒/皮疹、苏醒反应、肌阵挛、矛盾反应、咳嗽和打嗝。并发症包括氧饱和度<90%、呼吸抑制（呼吸频率<8次/分钟）、呼吸暂停、呼吸急促、低血压、高血压、心动过缓和心动过速。正常生命体征因年龄而异。次要结局是定义为手术完成的成功镇静。我们研究了不良事件和成功镇静与禁食状态之间的关联。
在3274次就诊中，2643次就诊的准确禁食状态已知。比较1388例禁食<8小时的患者与1255例禁食≥8小时的患者，发现副作用发生率分别为5.5%和4.5%（P = 0.28）；并发症发生率分别为11.9%和17.7%（P<0.001）；不良事件发生率分别为16.3%和21.5%（P<0.001），干预措施发生率分别为4.1%和4.4%（P = 0.73），手术完成率分别为94.3%和89.7%（P<0.001）。在对年龄、性别、转运状态、美国麻醉医师协会身体状况分类、种族、主要镇静剂、多种镇静剂、镇静剂加镇痛药以及主要镇痛药进行调整后，我们发现禁食状态与副作用（P = 0.68）、并发症（P = 0.48）或不良事件（P = 0.26）之间无关联；然而，禁食<8小时的手术完成率仍显著更高（P = 0.007）。
禁食状态≥8小时可能比禁食<8小时有相似或更差的结局，这与许多建议的指南相反。在急诊镇静患者中严格遵循禁食指南可能没有必要。
