Doctors have long made critically ill patients skip food for many hours before a procedure to place a breathing tube in their neck (called a tracheostomy). The idea was to prevent food from going into the lungs during surgery. But a new study of 222 ICU patients found that fasting for long periods didn’t actually prevent this complication. Instead, patients who fasted longer needed more oxygen after surgery and took much longer to get back to normal nutrition. The findings suggest that doctors should let patients eat closer to their surgery time, which could help them recover better.

The Quick Take

  • What they studied: Whether making ICU patients go without food for long periods before a breathing tube procedure actually prevents food from accidentally entering the lungs during surgery
  • Who participated: 222 adult patients in an intensive care unit who were receiving nutrition through a feeding tube and needed a tracheostomy procedure (a surgical opening in the neck to help with breathing)
  • Key finding: Patients who fasted for more than 12 hours had the same rate of food entering their lungs (40-54% across all groups) as those who fasted less than 1 hour, but they needed more oxygen support afterward and took much longer to resume normal feeding
  • What it means for you: If you or a loved one needs this procedure in an ICU, shorter fasting times may be safer and help with recovery. However, this is specialized ICU care—talk with your medical team about what’s best for your specific situation.

The Research Details

Researchers looked back at medical records from 222 ICU patients who had already undergone a tracheostomy procedure (a surgical opening in the neck to help with breathing). They divided patients into groups based on how long they had fasted before surgery—some went without food for less than 1 hour, some for 1-12 hours, and some for more than 12 hours. They then compared what happened to each group, looking at whether food entered their lungs, how much oxygen they needed, how quickly they could resume eating, and how long they stayed in the hospital.

This type of study is called a “retrospective observational study,” which means researchers examined records of things that already happened rather than conducting a new experiment. The researchers collected information about each patient’s breathing, nutrition, and overall health outcomes and compared the groups statistically.

This research approach is important because it looks at real-world practice in actual ICU patients rather than testing in a lab. The findings challenge a long-standing tradition in medicine, so examining actual patient outcomes helps doctors decide whether this traditional practice is truly necessary. Understanding what really happens to patients helps doctors make better decisions about care.

This study has some strengths: it included a reasonable number of patients (222) and looked at multiple important health outcomes. However, it’s a single-center study (only one hospital), which means results might be different at other hospitals. Because it’s retrospective, doctors couldn’t control all the factors that might have affected outcomes—some patients may have had different health conditions that influenced results. The study was observational rather than a controlled experiment, so we can see what happened but can’t be completely certain fasting caused the differences.

What the Results Show

The main finding was surprising: the rate of food entering the lungs during or after surgery was essentially the same regardless of fasting duration, ranging from 40.2% to 54.5% across all groups. This means that making patients fast for long periods didn’t prevent this complication.

However, patients who fasted for more than 12 hours needed significantly more oxygen support 48 hours after surgery (47.7% oxygen concentration) compared to those who fasted less than 1 hour (39.1% oxygen concentration). This suggests that prolonged fasting may have made their lungs work harder during recovery.

Another important finding was about nutrition recovery. Patients who fasted longer took much more time to reach their nutritional goals—an average of 33.5 hours for the prolonged-fasting group versus just 2.4 hours for the minimal-fasting group. This is a huge difference that could affect healing and strength recovery.

The study found no significant differences between fasting groups in how long patients stayed in the ICU, how long they stayed in the hospital overall, or mortality rates. This suggests that while prolonged fasting didn’t help prevent the main complication, it also didn’t appear to cause more deaths or longer hospital stays. However, the delayed nutrition recovery and increased oxygen needs are still concerning for patient comfort and healing.

This research challenges a long-standing medical practice. For decades, doctors have routinely made patients fast for many hours before procedures to reduce aspiration risk (food entering the lungs). This study suggests that this traditional approach may not be as necessary as previously thought. The findings align with growing evidence in other medical fields that shorter, more flexible fasting periods may be safer and better for patient recovery.

This study looked backward at existing records rather than randomly assigning patients to different fasting times, so we can’t be completely certain that fasting duration caused the differences observed. The study was conducted at only one hospital, so results might differ elsewhere. Doctors didn’t control all possible factors that could affect outcomes—some patients may have had different underlying conditions. The study couldn’t explain why prolonged fasting led to higher oxygen needs, so more research is needed to understand the mechanism.

The Bottom Line

Based on this evidence, ICU doctors should consider using shorter, individualized fasting periods before tracheostomy procedures rather than routinely requiring prolonged fasting. Patients should continue receiving nutrition through feeding tubes as close to the procedure time as medically safe. Confidence level: Moderate—this is one study from one hospital, so more research would strengthen these recommendations.

This research is most relevant to ICU doctors and critical care teams making decisions about pre-procedure fasting. It’s also important for ICU patients and their families who want to understand whether traditional fasting practices are truly necessary. This doesn’t apply to general surgery patients or non-ICU settings, which may have different risks and requirements.

If shorter fasting times are adopted, benefits should be apparent immediately—patients would resume nutrition faster and potentially need less oxygen support within the first 48 hours after surgery. However, the main complication (food entering lungs) occurred at similar rates regardless, so don’t expect this change to eliminate that risk entirely.

Want to Apply This Research?

  • For ICU caregivers using a medical app: Track fasting duration before procedures (in hours) alongside post-procedure oxygen requirements (as percentage) and time to reach nutritional goals (in hours). This creates a personalized record showing how fasting duration correlates with recovery metrics.
  • Work with your ICU care team to develop a shorter, individualized fasting protocol. Instead of automatically fasting 12+ hours, discuss whether 1-2 hours might be appropriate for your specific situation. Document the fasting duration used and monitor your oxygen needs and nutrition recovery afterward.
  • If you’re involved in ICU care decisions, establish a tracking system that records: (1) pre-procedure fasting duration, (2) oxygen requirements at 24 and 48 hours post-procedure, (3) time to reach caloric goals, and (4) any complications. Over time, this data helps identify the optimal fasting duration for individual patients rather than using a one-size-fits-all approach.

This research applies specifically to critically ill ICU patients undergoing tracheostomy procedures and should not be applied to other surgical settings or patient populations without medical guidance. Fasting recommendations vary greatly depending on the type of procedure, anesthesia used, and individual patient factors. Always follow your doctor’s specific pre-procedure instructions, as they understand your complete medical situation. This study challenges traditional practice but doesn’t eliminate the need for some fasting before procedures. Discuss appropriate fasting duration with your medical team before any procedure.