Change the preprocedural fasting policy for contrast-enhanced CT: results of 127,200 cases

Abstract

Objectives To analyze the relationship between the dietary preparation status prior to contrast-enhanced CT (CECT) and adverse drug reactions (ADR) and emetic complications. Methods Non-emergency adult patients who underwent routine CECT in our hospital from January 2019 to December 2020 were retrospectively analyzed. Stratified dietary preparation regimens were implemented for different clinical scenarios. The relationship between actual dietary preparation status and ADR and emetic complications was analyzed. Results A total of 127,200 cases were enrolled, including 49,676 cases in the fasting group (57 years ± 13, 56.79% men) and 77,524 cases in the non-fasting group (60 years ± 13, 54.55% men). No statistical difference was found in the overall incidence of ADR (0.211% vs. 0.254%, p = 0.126) or emetic complications (0.030% vs. 0.046%, p = 0.158) between the two groups, and no aspiration pneumonia or death occurred. For patients with an ICM-ADR history, the ADR incidence in non-fasting group was significantly lower than fasting group (2.424% vs. 12.371%, p = 0.002). For patients with hypertension, injection dose ≥ 100 mL, injection rate ≥ 5 mL/s, and Iopromide 370 usage, non-fasting was associated with higher ADR incidence (p < 0.05). 36.67% of the patients experienced unnecessary excessive fasting in practice. Excessive fasting (≥ 10 h) and more water ingestion (≥ 500 mL) within 1 h prior to CECT were associated with higher ADR incidence (p < 0.05). Conclusion Unrestricted food ingestion would not increase the overall risk of ADR and emetic complications. For some special patient subgroups, non-fasting, excessive fasting, and more water ingestion were associated with higher ADR incidence.

Effects of Fasting versus Non-Fasting on Emetic Complications in Radiological Examinations Using Intravascular Non-Ionic Iodinated Contrast Media: A Systematic Review and Meta-Analysis

“…After a full-text review of these 21 publications, 10 studies were finally included in the meta-analysis ( Fig. 1 , Table 1 ) [ 3 13 15 16 17 18 19 20 21 22 ]. The other 11 studies were excluded for the following reasons: non-English literature (n = 2), use of oral contrast rather than intravascular injections (n = 3), review (n = 3) or systematic review (n = 1) articles, studies that only evaluated the incidence of adverse events in the fasting group (n = 1), and research reporting the merged incidence of nausea and vomiting (n = 1).…”

Stratified assessment and warning regimen for prevention of acute adverse reactions to iodinated contrast media: results of 150,343 cases in a tertiary hospital

“…Non-ionic ICM were intravenously injected by a high-pressure injector (Ulrich Medical® Inc., Ulm, Germany). The injection doses and injection rates of ICM were adopted according to our institutional protocol [ 16 ]. The ICM used included Iodixanol 270 (GE Healthcare, London, UK), Ioversol 320 (Jiangsu Hengrui Medicine Co., Ltd, Jiangsu, China), Iodixanol 320 (Jiangsu Hengrui Medicine Co., Jiangsu, China), Iohexol 350 (Yangtze River Pharmaceutical Co., Ltd, Jiangsu, China), Iopamidol 350 (Bracco, Milan, Italy), Iobitridol 350 (Guerbet, Paris, France), and Iopromide 370 (Bayer Healthcare, Leverkusen, Germany).…”

“…formulation [9][10][11][12][13][14]. For the whole population, several prophylactic approaches have also been reported, such as lower dose and injection speed, extrinsic warming of ICM to 37℃, and stratified dietary preparation regimen [15][16][17][18]. However, there is a lack of solid high-quality evidence of their effectiveness [19][20][21].…”