Study of Enteral Nutrition in Aeromedically Evacuated Critically Ill/Injured Patients with a Resultant Validation Algorithm for the Theater Validating Flight Surgeon

Abstract

Early enteral feeding in critically ill/injured, especially burn/major trauma, patients benefits gut integrity and immunocompetence and reduces infections and intensive care unit/hospital stays. Aeromedical Evacuation (AE) often takes place concurrently. As a result, AE and early enteral feeding should be inseparable. This retrospective descriptive study was a first-look at early enteral feeding vis a vis AE. An uptick in feeding rates was found after the 2010 nutrition support clinical practice guideline (CPG), 15% to 17%. With the next two CPG iterations, rates rose significantly, 17% to 48%. At the same time, AE feeding holds rose significantly 10% to 24%, later dropping to 17%. It appeared the CPGs reinforced the value of feeding, but may well have sensitized to the threat of aspiration. In addition, little difference was found between those patients not enterally fed preflight and those enterally fed, this across collected demographic, mission, and clinical parameters. Likewise, no difference was found between those enterally fed during AE and those withheld. Yet, 83% of the studys patients were not fed and 18% of those that were had feeding withheld for AE. All suggesting early enteral feeding was under prescribed and AE feeding holds were overprescribed. An algorithm devised for the Theater Validating Flight Surgeon (TVFS) incorporated relevant preflight/inflight/clinical issues and employed prescriptions designed to boost feeding, diminish AE holding, and prevent complications. Notably, no AE enteral feeding outcome and aspiration studies are extant. In the future, with such studies, the TVFS algorithm can be updated into definitive, good to go inflight enteral feeding prescriptions.

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Document Details

Document Type
Technical Report
Publication Date
Aug 06, 2021
Accession Number
AD1156390

Entities

People

  • Andre D Gholson
  • Charles J Harding
  • Danny E. Smith
  • Kayla N. Brown
  • Sarah K Woody
  • Sarah L Huffman
  • Todd C Noe
  • William P. Butler

Organizations

  • 59th Medical Wing
  • 711th Human Performance Wing

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Feeding Methods
  • Health Services
  • Medical Personnel
  • Military Medicine
  • Patient Care
  • Spine
  • Statistical Analysis
  • Therapy
  • Warfare
  • Wounds And Injuries

Fields of Study

  • Medicine

Readers

  • Trauma or Military Medicine
  • Vector-Borne Disease and Entomology