Is pre-extubation fasting in ICU justified? Insights from a prospective observational study using gastric ultrasound

Background

In order to mitigate the risk of aspiration pneumonia, it is common practice to recommend fasting for critically ill patients who are undergoing elective tracheal extubation. This clinical investigation seeks to question and reassess this standard fasting protocol.

Aims & objectives

This study aimed to determine the role of gastric ultrasound in critically ill patients before a planned tracheal extubation. Main objectives of this study were to assess prevalence of at-risk stomach (full stomach) and the rates of safe extubation in fasted and non-fasted patients.

Methods

Gastric ultrasound was performed on 60 critically ill patients prior to tracheal extubation to assess cross-sectional area (CSA) and calculate gastric volume. Patients with a volume exceeding 1.5 mL/kg or thick fluid were classified as ‘at-risk’ for aspiration (full stomach). All patients were monitored for aspiration pneumonitis during the 24 h following extubation.

Results

The overall prevalence of at-risk stomachs (full stomach) was 40 %, showing no difference between fasted and non-fasted groups (50 % vs. 30 %; p = 0.114). Calculated gastric volumes were also similar across both groups (0.95 ± 0.58 vs. 0.86 ± 0.48 mL/kg; p = 0.574). The safe extubation rate did not significantly differ between fasted and non-fasted groups (86.7 % vs. 93.3 %; p = 0.39). Ongoing opioid use was identified as an independent predictor of at-risk stomach (adjusted odds ratio, 5.54; p = 0.016).

Conclusions

The prevalence of at-risk stomach (full stomach) was high in our cohort. Pre-extubation fasting did not decrease gastric volumes, as assessed by ultrasound, while ongoing opioid use was an independent predictor of an ‘at-risk’ stomach.