ASA has developed practice guidelines for preoperative fasting, most recently updated in 2017, with the goal of reducing the risk of pulmonary aspiration for healthy patients undergoing elective procedures. These current ASA “Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration” are well defined and remain essentially unchanged over the years. Many medical centers across the country strictly adhere to these practice guidelines for all cases, including the critically ill and critically injured, encompassing trauma and burns. They advise that a critically ill patient is at an increased risk of regurgitation and pulmonary aspiration, even if the practice guidelines are followed. However, one must weigh the risk of aspiration versus the need for high caloric input that burned and critically ill patients require. Studies over the past 20 years have shown the need for proper nutrition for ideal healing,...

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