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32 How Long Are Burn Patients Really NPO in the Perioperative Period and Can We Effectively Correct the Caloric Deficit Using an Enteral Feeding “Catch-up” Protocol?
Abstract Introduction “NPO at midnight” (NAM) is a standard preoperative practice intended to reduce aspiration risk on anesthetic induction and intubation. Burn patients requiring mechanical ventilation go to the operating room with protected airways, theoretically mitigating the aspiration risk. B...
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| Published in: | Journal of burn care & research 2018-04, Vol.39 (suppl_1), p.S21-S21 |
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| Main Authors: | , , |
| Format: | Article |
| Language: | English |
| Online Access: | Get full text |
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| Summary: | Abstract
Introduction
“NPO at midnight” (NAM) is a standard preoperative practice intended to reduce aspiration risk on anesthetic induction and intubation. Burn patients requiring mechanical ventilation go to the operating room with protected airways, theoretically mitigating the aspiration risk. By being NAM, these patients suffer unnecessary, prolonged feeding interruptions. Over the course of multiple surgeries, caloric deficits can be extensive. Postoperative hyperalimentation through a “catch-up” tube feeding (TF) protocol is routine. A retrospective review of our perioperative fasting practices and catch-up TF protocols was performed.
Methods
Patients treated in the Burn ICU from July 1st, 2015 to August 31st, 2016 with protected airways in place, on TFs, and scheduled for surgery were reviewed. Each non-airway/non-abdominal surgery was considered a discrete event. The time from NPO to surgical start (NPO-SS), NPO to feeding restart (NPO-FR), and calories received/prescribed were quantified. The outcomes of patients who received a postoperative catch-up TF protocol [(goal rate)*(hours NPO) given over 5 days] were also analyzed.
Results
Nineteen patients were included. Some underwent multiple surgeries, yielding 57 discrete perioperative events. The average total body surface area burn (38.1 ± 28.4%), age (44 ± 15.6 years), ICU days (47.9 ± 47.6 days), and ventilator days (37.8 ± 43.3 days) were calculated. Average NPO-SS and NPO-FR fasting times were 10.2 ± 2.4 and 16.1 ± 3.5 hours, respectively. The average caloric deficit to prescribed calories ratio during NPO-SS and NPO-FR periods were 1205 ± 596/3407 ± 748 kcal and 1910 ± 967/3407 ± 748 kcal, respectively. In 91.1% of preoperative events, patients were tolerating TFs. A postoperative catch-up protocol completely compensated for perioperative caloric deficits 66.7% of the time. The most common reason for failing the catch-up protocol was fasting for another surgery (37%).
Conclusions
Patients often fast preoperatively much longer than American Society of Anesthesiologists guidelines, resulting in greater than 50% average loss of prescribed calories on the day of surgery. Therefore, we believe clinicians should re-evaluate the standard preoperative practice of NAM. However, an effective catch-up protocol can adequately reduce caloric deficits. To our knowledge, this is the first study performed in burn patients that not only quantifies perioperative fasting but also the efficacy of a postoperativ |
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| ISSN: | 1559-047X 1559-0488 |
| DOI: | 10.1093/jbcr/iry006.036 |