Procedural Sedation in the Emergency Department - An Observational Study: Does Nil Per Os Status Matter?

Area of Science:

• Emergency Medicine
• Anesthesiology
• Patient Safety

Background:

• Procedural sedation (PS) is frequently administered in emergency departments (EDs).
• Current nil per os (nothing by mouth) (NPO) guidelines for PS are often adopted from operating room standards.
• The impact of NPO status on adverse events and PS success in the ED is not well-established by large studies.

Purpose of the Study:

• To investigate the association between NPO status and adverse events in ED procedural sedation.
• To determine the relationship between NPO status and the success rate of procedural sedation in the ED.

Main Methods:

• Retrospective analysis of a prospective database of consecutive ED PS patients across 20 diverse ED settings.
• Data collected over 183 months (April 2000–June 2015) included patient demographics, NPO status, side effects, complications, and procedural completion.
• Statistical analysis compared outcomes between patients with NPO <8 hours and NPO ≥8 hours, with adjustments for confounding factors.

Main Results:

• No significant association was found between NPO status (<8 hours vs. ≥8 hours) and the incidence of side effects, complications, or overall adverse events after adjustment.
• Patients with NPO <8 hours demonstrated a significantly higher procedural completion rate (94.3%) compared to those with NPO ≥8 hours (89.7%).
• Complication rates were higher in the NPO ≥8 hours group (17.7%) compared to the NPO <8 hours group (11.9%), though this difference was significant after adjustment.

Conclusions:

• Nil per os status of ≥8 hours may not offer superior or may even lead to worse outcomes compared to shorter NPO durations in ED procedural sedation.
• Strict adherence to prolonged NPO guidelines may not be necessary for all patients undergoing procedural sedation in the emergency department.
• Further research may be warranted to refine NPO guidelines for ED procedural sedation based on specific patient factors and procedural risks.