JOURNAL CLUB: Preparative Fasting for Contrast-Enhanced CT in a Cancer Center: A New Approach

Barbosa, Paula Nicole Vieira Pinto; Bitencourt, Almir Galvão Vieira; Tyng, Chiang Jeng; Cunha, Rodrigo Rodrigues da; Travesso, Demian Jungklaus; Almeida, Maria Fernanda Arruda; Chojniak, Rubens

doi:10.2214/ajr.17.19061

Cited by 25 publications

(17 citation statements)

References 8 publications

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“…This result may be consistent with the study by Oowaki et al, in which nausea and vomiting occurred more frequently in patients who fasted for longer periods before contrast-enhanced CT [7]. Barbosa et al [4] evaluated 3206 patients and reported that the incidence of some symptoms, such as flushing, dizziness, ear pruritus, tingling, tremor, pain at the injection site, tachycardia, and headache, was lower in the non-fasting group. The reason for the reduction in the incidence of nausea in our study is unclear for us.…”

Section: Discussionsupporting

confidence: 89%

“…However, there has been little evidence to support this practice. Our current study, along with previous studies [2,6], has confirmed not only the lack of benefit but also the possible disadvantages of fasting prior to contrastenhanced CT. Preparative fasting should be recommended only before specific types of imaging examinations, such as virtual gastroscopy and colonoscopy, 3D anatomic reconstruction for preoperative planning, and examinations performed under general anesthesia or sedation [4].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some investigators reported that the occurrence of nausea and vomiting lacked correlation with the preparative solid food status, suggesting solid food fasting was not essential [2][3][4]. In addition, since many patients may excessively fast fluids as well as solid food, they should be encouraged to prevent dehydration and not to excessively fast fluids, even when instructed to fast [3].…”

Section: Introductionmentioning

confidence: 99%

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The effect of abolishing instructions to fast prior to contrast-enhanced CT on the incidence of acute adverse reactions

et al. 2020

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Objectives To evaluate the effect of abolishing instructions to fast prior to contrast-enhanced CT on acute adverse reactions (AARs). Methods In our institution, we instructed patients to fast one meal before contrast-enhanced CT examinations. However, we abolished these instructions at the end of March 2019, and solid food intake was not restricted before contrast-enhanced CT after this date. The differences in the incidence of AARs before (December 2015–November 2018, n = 43,927) and after (April 2019–March 2020, n = 14,676) abolishing instructions to fast were compared. We allowed 4 months (December 2018–March 2019) for this policy change to fully permeate the CT referrals. The medical records of patients who vomited were retrospectively reviewed by one of the authors for notations of aspiration or aspiration pneumonia attributable to vomiting. Results The overall incidence of AARs before (1.60%, n = 705) and after abolition (1.40%, n = 205) did not change significantly. As the chemotoxic reactions, the incidence of nausea decreased significantly (0.31 to 0.18%, p = 0.006). The incidence of vomiting did not change (0.12 to 0.16%), and there were no cases of aspiration pneumonia attributable to vomiting during the study period. The incidence of severe hypersensitivity/allergy-like reactions did not change (0.06 to 0.05%). Conclusions Abolishing instructions to fast decreased the incidence of nausea, but did not affect the incidence of vomiting. No cases of aspiration pneumonia attributable to vomiting were found. Our study confirmed that fasting is not required prior to contrast-enhanced CT.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of abolishing instructions to fast prior to contrast-enhanced CT on the incidence of acute adverse reactions

et al. 2020

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“…No previous study has investigated the incidence of emetic complications in pediatric patients; nevertheless, the incidence reported in this study is within the range previously reported in fasting studies on adult patients (nausea and vomiting, 0.07-2.9%) (3,9,15,16). Given the retrospective nature of this study and the challenges inherent to the evaluation of nausea in young children who are sedated or unable to communicate with medical staff, it is possible that we underestimated the incidence of emetic complications.…”

Section: Discussionsupporting

confidence: 81%

“…Small children are particularly vulnerable to dehydration and hypoglycemia. Recently, several large-scale clinical studies on adult patients investigated the risk factors for emetic complications after ICM exposure ( 3 9 ). These studies showed that fasting duration was not associated with emetic complications, and the authors did not recommend excessive fasting because of the risks of dehydration and contrast media-induced nephropathy.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of Nausea and Vomiting after Exposure to Low-Osmolality Iodinated Contrast Media in Children: A Focus on Preparative Fasting

Choi

Cho

et al. 2020

Korean J Radiol

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Objective: To evaluate the incidence and risk factors of emetic complications associated with the intravenous administration of low-osmolality iodinated contrast media (ICM) in children undergoing computed tomography (CT). Materials and Methods: All children who underwent contrast-enhanced CT between April 2017 and July 2019 were included. Pediatric patients were instructed on the preparative dietary protocol at our institution. Experienced nurses in the radiology department monitored the children during the CT scans and recorded any emetic complications in their electronic medical records. These data were used to calculate the incidence of emetic complications. Various patient factors and technical factors, including fasting duration, the type and volume of ICM, and ongoing chemotherapy, were evaluated to identify risk factors for emetic complications using univariate and multivariate logistic regression analyses. Results: Among the 864 children (mean age, 8.4 ± 5.7 years) evaluated, 18 (2.1%) experienced emetic complications (6 experienced nausea only and 12 experienced nausea and vomiting). None of the children developed aspiration pneumonia. The mean fasting duration of patients with emesis was 7.9 ± 5.7 hours (range, 3-21 hours), whereas that of patients without nausea was 8.7 ± 5.7 hours (range, 0-24 hours). Fasting duration was not associated with the development of nausea and vomiting (p = 0.634). Multivariate logistic regression analysis revealed that ongoing chemotherapy (odds ratio [OR] = 4.323; 95% confidence interval [CI] = 1.430-13.064; p = 0.009), iomeprol use (OR = 7.219; 95% CI = 1.442-36.146; p = 0.016), and iohexol use (OR = 5.241; 95% CI = 1.350-20.346; p = 0.017) were independent risk factors for emetic complications. Conclusion: Only a small proportion (2.1%) of children experienced nausea or vomiting after exposure to low-osmolality ICM. Many children underwent excessive fasting; however, fasting duration was not associated with nausea and vomiting. Moreover, ongoing chemotherapy and the use of iomeprol or iohexol were identified as potential risk factors for emetic complications in children.

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Value-Based Radiology in Thoracic Imaging

Silva

Kauczor

2019

Value-Based Radiology

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JOURNAL CLUB: Preparative Fasting for Contrast-Enhanced CT in a Cancer Center: A New Approach

Cited by 25 publications

References 8 publications

The effect of abolishing instructions to fast prior to contrast-enhanced CT on the incidence of acute adverse reactions

The effect of abolishing instructions to fast prior to contrast-enhanced CT on the incidence of acute adverse reactions

Incidence and Risk Factors of Nausea and Vomiting after Exposure to Low-Osmolality Iodinated Contrast Media in Children: A Focus on Preparative Fasting

Value-Based Radiology in Thoracic Imaging

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