Effect of Duration of Pre-Procedure Fasting on Clinical Outcomes in Intensive Care Patients Undergoing Percutaneous Tracheostomy

BACKGROUND Prolonged pre-procedural fasting before percutaneous tracheostomy is traditionally practiced to reduce aspiration pneumonia risk in critically ill patients; however, its clinical impact remains unclear. This study primarily evaluated the effect of fasting duration on aspiration pneumonia and secondarily assessed respiratory, nutritional, and clinical outcomes. MATERIAL AND METHODS This single-center retrospective observational study included 222 adult intensive care unit (ICU) patients who underwent percutaneous tracheostomy with enteral nutrition. Patients were grouped by fasting duration (<1 h, 1-4 h, 5-12 h, >12 h). Clinical, respiratory, nutritional, and outcome variables were analyzed. RESULTS The incidence of aspiration pneumonia ranged from 40.2% to 54.5%, with no significant differences between fasting groups (P=0.421). Patients fasting >12 hours had higher mechanical ventilation FiO₂ requirements 48 hours after tracheostomy compared with those fasting <1 hour (47.7% vs 39.1%; P=0.001). The time to reach caloric targets was substantially longer in the prolonged-fasting group (33.5±24.4 vs 2.4±9.0 hours; P<0.001). No significant differences were observed in ICU stay, hospital stay, or mortality. CONCLUSIONS Prolonged pre-tracheostomy fasting did not reduce the incidence of aspiration pneumonia but was associated with increased oxygen requirements and delayed nutritional recovery. Avoiding unnecessary interruptions of enteral nutrition and using shorter, individualized fasting strategies may optimize outcomes in critically ill patients. These findings indicate that routinely applied prolonged fasting durations offer no clinical benefit and may adversely affect metabolic and respiratory stability in this patient population.