• Nathan Gonik, Andrew Tassler, Thomas J Ow, Richard V Smith, Stefan Shuaib, Hillel W Cohen, Catherine Sarta, and Bradley A Schiff.
• Department of Otorhinolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA nathangonik@gmail.com.
• Otolaryngol Head Neck Surg. 2016 Jan 1; 154 (1): 87-93.

ObjectiveAmerican 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.Study DesignRandomized blinded controlled trial.SettingTertiary academic medical center.SubjectsICU patients undergoing bedside tracheotomy.MethodsIntubated 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.ResultsTwenty-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.ConclusionsShortening preoperative fasts in intubated ICU patients allowed for better caloric delivery in the preoperative period.© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

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