No Association Between Preprocedural Fasting and Witnessed Pulmonary Aspiration: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated whether preprocedural fasting reduces the risk of witnessed pulmonary aspiration. Across 2,105 patients, aspiration was rare and not influenced by liberal vs restrictive fasting regimens (odds ratio 1.17, 95 percent CI 0.32–4.23). Trial sequential analysis indicated that further studies are unlikely to change this conclusion. Most prior evidence supporting fasting relied on surrogate outcomes such as gastric volume and pH, which have never been shown to correlate with clinical aspiration. The authors conclude that there is no evidence linking liberal fasting to aspiration and suggest that fasting policies could be liberalized, potentially guided by bedside gastric ultrasound.