American Society of Anesthesiologists Guidance on Periprocedural Fasting in Patients Receiving Tube Feeding
Jamie L. Sparling, Thomas Edmiston, Prashant Nasa, Ravindra A. Gupta, Kunal Karamchandani, Ashish K. Khanna, Jarva Chow, Federico Bilotta, Alisha Sachdev, Roshni Sreedharan, Shahla Siddiqui, Paul E. Wischmeyer, Christian Stoppe, Jeffrey I. Mechanick, D. Dante Yeh, Ronald G. Pearl, Todd W. Rice, Hassan S. Dashti, Michael DeWane, Martin Rosenthal, Richard P. Dutton, Alexander Nagrebetsky,In the absence of guidelines from professional societies, periprocedural fasting practices in enteral nutrition vary widely and often lead to preventable, clinically significant nutritional deficits. To address the heterogeneity of current clinical practice, the authors aimed to develop expert consensus on best practices for the periprocedural management of tube feeding using a modified Delphi consensus process. Draft recommendations were iteratively modified during a four-round Delphi process by a multidisciplinary international panel of experts. After iterative consolidation and modification, a total of 20 recommendations were produced by round 4, and all recommendations achieved stability. Final recommendations advocate for the protocolization of institutional perioperative fasting approaches and establish best practices for perioperative management of tube feeding in patients with and without a secure airway (cuffed endotracheal or cuffed tracheostomy tube) across a range of common clinical scenarios. The recommendations are intended to harmonize local practices internationally and safely minimize unnecessary periprocedural nutritional loss.