Immediate "sipping" vs. delayed oral fluid intake after extubation: A randomized controlled trial.

Purpose: Despite advances in perioperative care, delayed oral fluid intake after extubation remains common and is often based on tradition rather than evidence. This study aimed to evaluate whether immediate oral fluid intake "sipping" after extubation reduces thirst and discomfort and is safe in an intensive care setting.

Methods: In this single-center, prospective, randomized controlled trial, 160 ICU patients who met extubation criteria were randomized 1:1 to either delayed fluid intake (2 h post-extubation) or immediate sipping (up to 3 ml/kg over 2 h). Thirst, discomfort, and adverse effects (nausea, vomiting, aspiration) were assessed at 0, 5, 30, 60, 90, and 120 min. Thirst relief was also evaluated in the experimental group. Statistical significance was set at p < 0.05.

Results: At 120 min, 64 of 80 patients in each group (80 %; 95 % CI: 70-88 %) reported thirst. The difference between groups was 0.0 % (95 % CI: -12 % to 12 %; p = 1.000). However, thirst relief between baseline and 120 min was observed in 11.3 % of patients in the sipping group (95 % CI: 5-20 %) vs. 1.3 % in the standard group (95 % CI: 0-7 %), with a difference of 10 % (95 % CI: 1-19 %; p = 0.0338). At 90 min, throat discomfort was present in 23.8 % of the sipping group (95 % CI: 15-35 %) vs. 42.5 % in the standard group (95 % CI: 32-54 %), with a difference of -18.7 % (95 % CI: -34 % to -3 %; p = 0.0118). Adverse effects (nausea, vomiting) were rare and comparable; no aspiration events were observed.

Conclusion: Immediate oral fluid intake "sipping"after extubation appears to be safe, improves thirst relief, and reduces discomfort in ICU patients without increasing adverse effects. These findings challenge traditional fasting practices and support early rehydration in post-extubation care.

Trial registration: The trial was registered at ClinicalTrials.gov on January 6, 2023 (Identifier: NCT05819645).