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Real fasting times and incidence of pulmonary aspiration in children: Results of a German prospective multicenter observational study
背景与目的
麻醉前长时间禁食在小儿手术中很常见。缩短禁食时间可以改善麻醉诱导过程中的代谢和血流动力学状况，改善父母和孩子的围术期体验，简化围术期管理。德国的一些手术中心降低了禁食要求，但国家指南仍未改变。因此，这项前瞻性的多中心观察性研究是由德国麻醉学和重症监护医学学会儿童麻醉科学工作组发起的，目的是在修订国家禁食指南之前评估实际禁食时间和吸入性肺炎发病率的相关性。
方 法
在伦理委员会批准后，至少有3000名儿童计划参与这项分析。使用标准化的病例报告记录患者的人口统计数据、实际禁食时间、麻醉和外科手术程序以及出现的反流或吸入性肺炎发生率。结果以中位数或发生率(百分比)表示。
结 果
2018年10月至2019年5月，10个儿童中心共纳入3324名儿童。大餐的实际禁食时间为14[12.2-15.6](0.5-24)小时，简餐9[5.6-13.3](0.25-28.3)小时，配方奶5.8[4.5-7.4](0.9-24)小时，母乳4.8[4.2-6.3](1.3-25.3)小时，清液2.7[1.5-6](0.03-22.8)小时。据报道，长期禁食(偏离指南>2小时)的情况有88.3%发生在大餐中，54.7%发生在简餐中，44.4%发生在配方奶中，25.8%发生在母乳中，34.2%发生在透明液体中。报告11例(0.33%)返流，4例(0.12%)疑似误吸，2例(0.06%)确诊吸入性肺炎;手术结束后均可拔管，恢复正常。
结 论
本研究表明，长时间禁食在德国儿科麻醉中仍较为常见，术后发生呼吸窘迫的肺误吸较为少见，急需对现行的局部禁食方案和国家禁食指南进行改进。
原始文献摘要
BACKGROUND: Prolonged fasting before anesthesia is still common in children. Shortened fasting times may improve the metabolic and hemodynamic condition during induction of anesthesia and the perioperative experience for parents and children and simplify perioperative management. As a consequence, some centers in Germany have reduced fasting requirements, but the national guidelines are still unchanged.
AIMS:This prospective multicenter observational study was initiated by the Scientific Working Group for Pediatric Anesthesia of the German Society of Anesthesiology and Intensive Care Medicine to evaluate real fasting times and the incidence of pulmonary aspiration before a possible revision of national fasting guidelines.
METHODS:After the Ethics Committee's approval, at least 3000 children were planned to be enrolled for this analysis. Patient demographics, real fasting times, anesthetic and surgical procedures and occurrence of regurgitation or pulmonary aspiration were documented using a standardized case report form. Results were presented as median [interquartile range] (range) or incidence (percentage).
RESULTS:At ten pediatric centers, 3324 children were included between October 2018 and May 2019. The real fasting times for large meals were 14 [12.2-15.6] (0.5-24) hours, for light meals 9 [5.6-13.3] (0.25-28.3) hours, for formula milk 5.8 [4.5-7.4] (0.9-24) hours, for breast milk 4.8 [4.2-6.3] (1.3-25.3) hours and for clear fluids 2.7 [1.5-6] (0.03-22.8) hours. Prolonged fasting (deviation from guideline >2 hours) was reported for large meals in 88.3%, for light meals in 54.7%, for formula milk in 44.4%, for breast milk in 25.8% and for clear fluids in 34.2%. Eleven cases (0.33%) of regurgitation, four cases (0.12%) of suspected pulmonary aspiration and two cases (0.06%) of confirmed pulmonary aspiration were reported; all of them could be extubated after the end of the procedure and recovered without any incidents.
CONCLUSION:This study shows that prolonged fasting is still common in pediatric anesthesia in Germany that pulmonary aspiration with postoperative respiratory distress is rare and that improvements to current local fasting regimens and national fasting guidelines are urgently needed.
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