title: Preparative fasting for contrast-enhanced CT: reconsideration.
abstract: OBJECTIVE
  To evaluate the evidence on the value of preparative fluid fasting for patients undergoing elective computed tomography (CT) with intravenous administration of contrast material and to survey leading institutions in a number of countries on their current policies in this regard.
  
  
  METHODS
  This study qualified for exempt status by the institutional review board. First, 20 keyword combinations were entered into Medline to ascertain the correlation between fluid ingestion preceding contrast material-enhanced CT and development of aspiration pneumonia. The numbers of patients were summed up to estimate incidence of aspiration pneumonia attributable to ingestion of clear inert fluid before contrast-enhanced CT examination. Second, a multinational survey was conducted about the length of preparative fasting protocols, if any, for fluids and solids that they recommend to patients before elective non-gastrointestinal contrast-enhanced CT.
  
  
  RESULTS
  Aspiration was not noted in any of 2001 patients (13 studies in the literature) who underwent contrast-enhanced CT after fluid ingestion. Data were available from 69 (86.3%) of 80 institutions queried (17 Korean, 14 U.S., 11 French, 10 Australian, 10 German, and seven Egyptian hospitals). Two-thirds (14 of 21 [66.7%]) of the French and German hospitals had a no-restriction policy for both fluids and solids, while Australian hospitals had a policy liberal about fluids (no restrictions in eight of 10 [80%]) only. Policies on fluids were variable in Korea, the United States, and Egypt (restrictions of 0-8 hours, 0-4 hours, and 0-6 hours, respectively), as were policies on solids in Korea, the United States, Australia, and Egypt (restrictions of 0-8 hours, 0-6 hours, 0 to 4-6 hours, and 0 hours to overnight, respectively). The length of fasting was longer for solids than for fluids in 20 hospitals.
  
  
  CONCLUSIONS
  There is little evidence that ingestion of clear inert fluid prior to contrast-enhanced CT is a cause of aspiration pneumonia; the length of fasting is variable in any country, being much longer in some hospitals than in others.
authors.affiliation: Department of Radiology, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea.
authors.forename: Bae-Young
authors.initials: BY
authors.lastname: Lee
authors.forename: Jin-Ju
authors.initials: JJ
authors.lastname: Ok
authors.forename: Abdelrahman Adel
authors.initials: AA
authors.lastname: Abdelaziz Elsayed
authors.forename: Youngjin
authors.initials: Y
authors.lastname: Kim
authors.forename: Dae Hee
authors.initials: DH
authors.lastname: Han
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage*; D005215:Fasting; D006801:Humans; D015994:Incidence; D016134:Organizational Policy; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media