title: Randomized Controlled Trial Assessing the Feasibility of Shortened Fasts in Intubated ICU Patients Undergoing Tracheotomy.
abstract: OBJECTIVE
  American Society of Anesthesiology guidelines recommend preoperative fasts of 6 hours after light snacks and 8 hours after large meals. These guidelines were designed for healthy patients undergoing elective procedures but are often applied to intubated intensive care unit (ICU) patients. ICU patients undergoing routine procedures may be subjected to unnecessary prolonged fasts. This study tests whether shorter fasts allow for better nutrition delivery and patient outcomes without increasing the risk.
  
  
  METHODS
  Randomized blinded controlled trial.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  ICU patients undergoing bedside tracheotomy.
  
  
  METHODS
  Intubated ICU patients who were receiving enteral feeding and for whom bedside tracheotomy was indicated were enrolled prospectively and randomly allocated to 2 parallel preoperative fasting regimens: a 6-hour fast (control) and a 45-minute fast (intervention). Patients were assessed for aspiration, caloric delivery, metabolic markers, and infectious and noninfectious complications.
  
  
  RESULTS
  Twenty-four patients were enrolled and randomized. There were no complications related to the procedure. There were no cases of intraoperative aspiration identified. There was a single postoperative pneumonia in the control group. Median (interquartile range) length of fast and caloric delivery were significantly different between the control group and the shortened fast group: 22 hours (18, 34) vs 14 hours (5, 25; P < .001) and 429 kcal (57, 1125) vs 1050 kcal (825, 1410; P = .01), respectively.
  
  
  CONCLUSIONS
  Shortening preoperative fasts in intubated ICU patients allowed for better caloric delivery in the preoperative period.
authors.affiliation: Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA nathangonik@gmail.com.
authors.forename: Nathan
authors.initials: N
authors.lastname: Gonik
authors.affiliation: Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tassler
authors.affiliation: Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ow
authors.affiliation: Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.affiliation: Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Shuaib
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sarta
authors.affiliation: Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Schiff
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D005215:Fasting; D005240:Feasibility Studies; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D013997:Time Factors; D014140:Tracheotomy / Q000592:standards*
keywords: ICU; enteral; fast; nutrition; preoperative; tracheotomy