Fasting times in the Pediatric Intensive Care Unit

Abstract

Adequate enteral nutrition is associated with improved outcomes in hospitalized children. Common interruptions to enteral nutrition include fasting status for planned procedures. We sought to describe current fasting duration for patients in the pediatric intensive care unit (PICU) undergoing planned anesthesia events. We completed a retrospective cohort study of patients ≤21 years old in a PICU from January 2015 to December 2020 who underwent a procedure or imaging study and were tolerating enteral nutrition prior to the procedure. A total of 189 patients met inclusion criteria. Anesthesia events requiring NPO status included radiologic studies (32.8%), neurosurgery (19.6%) and general surgery (13.8%). The median duration of fasting status was 13.3 h (IQR 8.0–23.0), exceeding recommendations of 2–6 h at our institution. Thirty-five patients (18.5%) were intubated prior to NPO status. Forty-five (23.8%) of NPO orders were placed to start at midnight. This study shows that fasting duration in children previously tolerating enteral nutrition in the PICU can exceed the recommended minimum duration in non-emergent cases requiring anesthesia. An opportunity exists to evaluate barriers and facilitators to enhance active decision making surrounding fasting status for hospitalized patients undergoing planned anesthesia events to maximize nutrition and minimize harm.