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Prolonged nil per os (NPO) status, or holding enteric feeds, did not increase respiratory complications in intubated, critically ill patients undergoing surgery. These findings challenge common practices regarding pre-operative fasting for critically ill surgical patients.

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Area of Science:

  • Critical Care Medicine
  • Surgical Nutrition
  • Respiratory Physiology

Background:

  • Nutritional support is vital for patient outcomes.
  • Critically ill patients often experience prolonged nil per os (NPO) status before surgery.
  • Current practices may exceed recommended fasting guidelines.

Purpose of the Study:

  • To investigate the relationship between the duration of nil per os (NPO) status and respiratory outcomes.
  • To compare adverse respiratory events in intubated, critically ill patients based on pre-operative NPO duration.
  • To evaluate adherence to fasting guidelines in intensive care units.

Main Methods:

  • Retrospective analysis of intubated, critically ill patients undergoing surgery (2016-2018).
  • Comparison of respiratory outcomes between patients with NPO ≥6 hours (NPO group) and NPO <6 hours (non-NPO group).
  • Inclusion criteria: intubated, critically ill patients requiring operative intervention.

Main Results:

  • No significant difference in aspiration (5.8% vs 7.3%), desaturation (16.3% vs 14.6%), pneumonia (18.3% vs 19.8%), or reintubation rates (13.5% vs 16.7%) between groups.
  • Median NPO duration was significantly longer in the NPO group (13.0 hours) compared to the non-NPO group (1.0 hour).
  • P-values for all respiratory outcomes were non-significant (P > 0.05).

Conclusions:

  • No increased risk of adverse respiratory events was observed for intubated, critically ill patients kept nil per os (NPO) for ≥6 hours compared to <6 hours.
  • Patients frequently experienced NPO durations exceeding the American Society of Anesthesiologists' 6-hour recommendation.
  • Findings suggest current NPO practices may be unnecessarily prolonged without clear respiratory benefit.