Procedural Sedation in Emergency Department: NPO Status Impact
Examining the impact of NPO status on adverse events in emergency department patients undergoing procedural sedation. Findings suggest that while adverse event rates are higher with NPO >8 hours, NPO status alone may not predict odds accurately, emphasizing the consideration of ASA class.
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Procedural Sedation in the Emergency Department: Does NPO Status Matter? Mace SE and Peterson B
Background Elective procedural sedation requires fasting (NPO) > 8 hours to limit complications These recommendations are from anesthesiology studies It remains controversial whether this 8-hour rule should be applied to the ED
Study Objectives Analyze the effect of NPO status on adverse events in ED patients undergoing procedural sedation Identify a cutoff time that increases or decreases risk of adverse events based on NPO time alone
Methods Prospective registry of 3,274 sequential hospital- wide sedation forms (2000-2015) retrospectively analyzed Outcomes Descriptive statistics of demographics, ASA class, NPO time, adverse events Chi-squared test for adverse events < 8 hours NPO vs > 8 hours NPO Logistic regression and ROC curve construction for effect of NPO on adverse events
Results 3,274 procedural sedations 2000-2015 exclude 718 procedural sedations without documented NPO 2,556 NPO statues documented for procedural sedation ASA 5 Age Range: 0.15-94 years ASA 4 Median Age: 37 years (IQR 10-62) ASA 3 ASA 2 ASA 1 Female = 44.0% (1,125) Male = 56.0% (1,431) 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%
Results NPO Status Median = 7.8 hours (IQR 5.9 11.3) Range = 0-36 hours Adverse Events Complications Side Effects Overall 18.9% 14.6% 5.2% NPO < 8 hours 16.6% 12.0% 5.7% 2 Test p = 0.0019 NPO > 8 hours 21.4% 17.5% 4.7%
Results NPO Status Median = 7.8 hours (IQR 5.9 11.3) Range = 0-36 hours Adverse Events Complications Side Effects Overall 18.9% 14.6% 5.2% NPO < 8 hours 16.6% 12.0% 5.7% 2 Test p = 0.0019 NPO > 8 hours 21.4% 17.5% 4.7%
Conclusions In ED patients undergoing procedural sedation, the incidence of adverse events its significantly greater for NPO >8 hours However, NPO status alone is not predictive of adverse event odds, and ASA class should be considered
