Institutional practices of withholding enteral feeding from intubated patients.
OBJECTIVE
This study compared the practices of anesthesia, anesthesia critical care, surgical critical care, and medical critical care departments that have training programs for the length of time they withhold enteral feeding from intubated patients before seven scheduled procedures: 1) extubation; 2) tracheostomy; 3) abdominal surgery; 4) nonabdominal surgery; 5) magnetic resonance imaging or computerized tomography; or placing the patient in the 6) Trendelenberg or 7) prone position.


METHODS
One-time survey of 297 anesthesia and critical care training programs in the United States.


RESULTS
Eighty programs responded (27%). We compared the median hours of withholding enteral feeding of intubated patients according to training program type for each of the procedures. None of the programs withheld enteral feeds from intubated patients scheduled for magnetic resonance imaging/computerized tomography scans, nor for the Trendelenberg position (median = 0 hour). A significant difference among program types was found for extubation, with anesthesia departments having significantly longer times (median = 6 hours) compared with anesthesia critical care (median = 4 hours), surgical critical care (median = 2 hours), and medical critical care (1.5 hours) departments (chi = 8.77, df = 3, p = 0.032). For scheduled tracheostomy, surgical critical care departments reported shorter times (median = 4 hours) than did all other surveyed departments (median = 6 hours) (chi = 7.28, df = 3, p = 0.063).


CONCLUSIONS
Differences in opinion exist among specialty training programs about the length of time necessary for withholding enteral feeding from intubated patients before scheduled procedures, especially extubation and tracheostomy. To resolve physician conflicts and to best serve these patients, best practice guidelines for withholding enteral feeding from intubated patients before scheduled procedures need to be developed jointly by the critical care specialties.
Schneider
Jeffrey A
JA
Department of Anesthesia, UMDNJ-Robert Wood Johnson University Hospital, New Brunswick, NJ, USA. jschneider01@gmail.com
Lee
Young J
YJ
Grubb
William R
WR
Denny
John
J
Hunter
Christine
C
D000005:Abdomen / Q000601:surgery; D000776:Anesthesiology; D003422:Critical Care; D003952:Diagnostic Imaging; D004750:Enteral Nutrition; D019538:Health Care Surveys; D006801:Humans; D007441:Intubation, Gastrointestinal; D011187:Posture; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care; D014139:Tracheostomy; D014481:United States