A descriptive analysis on the effects of NPO status on intubated, critical trauma patients undergoing surgery
Margaret Siu, Aixa M. Perez Coulter, Reginald Alouidor, Michael V. Tirabassi
Surgery, Baystate Medical Center-UMASS Medical School, Springfield, Massachusetts, United States
Objective: Describe the relationship between duration of nil per os (NPO) status and respiratory outcomes in intubated, critically ill trauma patients requiring operative intervention. Design: This was a retrospective cohort study of intubated, critically ill trauma patients who underwent operative intervention between January 1st 2016 and December 31st 2018 at a Level 1 trauma center in western Massachusetts. Variables collected included whether a patient was NPO for 6 hours (the NPO group) or < 6 hours (the non-NPO group) prior to procedure, demographics, operative procedures, respiratory adverse events including aspiration, pneumonia, desaturation episodes, reintubation, and number of ventilation days. Statistical analysis was completed using ANOVA and Chi-square test. Setting: Due to the concern of aspiration risks during intubation, the American Society of Anesthesiology (ASA) recommends 6 hours fast for food and 2 hours fast for clear liquids prior to operative procedures to prevent respiratory complications. We investigated the relationship between different hours of NPO status and the rendering of adverse respiratory events on a specific group of patients. Patients or other participants: Trauma patients of all ages requiring intubation, intensive care unit (ICU) admission, and operative intervention between January 1st 2016 and December 31st 2018. Main outcome measures: Difference in adverse respiratory events in intubated, critically ill trauma patients requiring operative intervention between those who followed the ASA guideline and those who did not. Results: A total of 76 patients met inclusion criteria, 36 in the NPO group and 40 in the non-NPO group. Comparing NPO with non-NPO, there were 97.2% vs. 92.5% of patients identified from the surgery ICU, 2.8% vs. 0% of patients from medical ICU, and 0% vs. 7.5% of patients from pediatric ICU; p=0.15. Percentage of male patients found in NPO and non-NPO groups were 80.6% vs. 67.5%, respectively; and 19.4% vs. 32.5% for females, respectively; p=0.2. Median NPO time was 13 hours in the NPO group and 2 hours in non-NPO, p<0.05. Aspiration events were found in 2.8% of patients who were NPO and 7.5% in those who were non-NPO, p=0.36. Desaturation events occurred in 8.3% in NPO and 5% in non-NPO, p=0.56. Pneumonia was found in 19.4% of patients who were NPO and 22.5% in non-NPO, p=0.74. Reintubation rates were 12.1% in NPO and 17.9% in non-NPO, p=0.53. Conclusion: There were fewer aspiration events, pneumonia cases, and reintubations in intubated, critically ill trauma patients requiring operative intervention when NPO was greater than 6 hours prior to procedure. However, the differences were not statistically significant. The median NPO time for patients in the NPO group was 13 hours, over twice the requirement to meet the ASA guidelines. Additional studies are needed to assess effects of enteric feed on respiratory complications in this patient population.
Back to 2022 Posters