• Christy G Barrick, Mary W Stewart, and Michelle Palokas.
• 1School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA 2Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence.
• JBI Evid Synth. 2020 Aug 1; 18 (8): 1701-1723.

ObjectiveThe objective of this scoping review was to examine and map fasting times for intubated adult patients in the intensive care unit prior to general anesthesia, and patient outcomes following the cessation of enteral nutrition.BackgroundMalnutrition in critically ill patients in the intensive care unit has been associated with increased infectious morbidity, increased length of intensive care unit and hospital stay, increased rate of infections, increased number of ventilator days, and impaired wound healing. One potential contributor to malnutrition is prolonged fasting times prior to general anesthesia. The American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine recommend minimizing fasting times prior to surgery; however, neither gives guidelines for intubated patients in the intensive care unit. By limiting fasting times with cuffed endotracheal tubes, nutritional goals could be improved without additional complications.Inclusion CriteriaThis scoping review considered studies that included patients in the intensive care unit who were 18 years and older possessing a cuffed endotracheal tube, requiring enteral nutrition, and undergoing surgery requiring general anesthesia. Specifically, fasting protocols, location of enteral nutrition being delivered, and patient outcomes were mapped for studies meeting these criteria. The review also looked at available protocols for preoperative fasting times for patients with cuffed endotracheal tubes prior to surgical procedures requiring anesthesia.MethodsThe JBI methodology was followed to complete this scoping review. The objectives, inclusion criteria, and methods of analysis for this review were previously established and documented in an a priori protocol.ResultsThree studies, one prospective observational study, and two retrospective chart reviews, with a total of 128 participants, were included in this review. Also, eight fasting protocols regarding adult intensive care unit patients with cuffed endotracheal tubes prior to general anesthesia were identified.ConclusionsThe identified studies and protocols conclude that institutions apply different fasting times depending on procedure types and feeding access for patients with cuffed endotracheal tubes. Some protocols require fasting to begin at midnight on the day of the procedure, while others allow enteral nutrition to be continued throughout the procedure. All identified protocols exclude some procedures from a reduced fast, typically airway procedures and abdominal surgeries. Each institution has specific requirements for patients that qualify for a reduced fast - such as feeding tube location, type of procedure, and positioning during the procedure - as well as specific times for enteral nutrition to be held. Following review of the studies, no aspiration events were witnessed during any operative procedure where a reduced fast was used.

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