Enteral Feeding Practices for U.S. Service Members in a Deployed Combat Support Hospital

Stankorb, Susan M.; Salgueiro, Esther; Grediagin, Ann

doi:10.7205/milmed-d-01-8908

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…In past conflicts such as Operation Iraqi Freedom and Operation Enduring Freedom, the United States maintained control of the airspace and, with that, casualties were evacuated out of the theater and to a level 5 facility in the United States within 2-3 days of the point of injury [62,63]. Due to this, the average length of stay at a combat support hospital (CSH) was only about 17.4 h, which includes any required surgery and preparation for evacuation, leaving little time for a nutrition evaluation by a dietitian [63].…”

Section: Enteral Nutrition In the Austere Environmentmentioning

confidence: 99%

Nutrition Considerations for Burn Patients: Optimizing Recovery and Healing

Shields,

Nakakura

2023

EBJ

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The hypermetabolic and hypercatabolic responses to severe burns put nutrition support at the forefront of treatments. When left untreated, severe weight loss, increased infection, and wound healing failure can occur. Enteral nutrition is the primary method of nutrition support in such patients. Meeting caloric needs and a positive nitrogen balance are short-term goals of nutrition support, with long-term goals of minimizing lean body mass loss and maximizing wound healing. High-carbohydrate and low-fat nutrition received evidence from randomized controlled trials of aiding in decreasing pneumonia rates and was found to promote positive nitrogen balance, which lipids do not do. We go through the macronutrient and micronutrient needs of the burn patient as well as techniques for meeting these needs in the modern intensive care unit, with some discussion of alterations in these techniques that are required in the austere environment.

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Section: Enteral Nutrition In the Austere Environmentmentioning

confidence: 99%

Nutrition Considerations for Burn Patients: Optimizing Recovery and Healing

Shields,

Nakakura

2023

EBJ

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“…casualties rarely receive parenteral nutrition (PN) or enteral nutrition (EN) support therapies in the combat zone. A 2009 publication examined enteral feeding practices for 209 U.S. service members treated at a deployed CSH over a 3‐month period in 2006 12 . Only 11% of candidates for early EN received a recommendation for nutrition support from the dietitian, and none initiated feeding at the CSH.…”

Section: Nutrition Support In System Of Combat Casualty Carementioning

confidence: 99%

“…The process of flying critically ill patients gives rise to unique considerations for providing nutrition support, which traditional practice guidelines do not address 12 . First, CCAT flights offer only limited space to provide care.…”

Section: Nutrition Support In System Of Combat Casualty Carementioning

confidence: 99%

“…First, CCAT flights offer only limited space to provide care. Concerns regarding increased aspiration risk as a result of gravitational forces and hypobarometric pressure, difficulty administering and monitoring tolerance to feeds with jostling during flight, high noise levels, presence of dirt and sand, restricted space, and poor lighting during flight yield caution with provision of EN support 12 , 15 , 18 . However, military care providers recognize the role of nutrition support in the traumatically injured and aim to provide the benefits of early EN when feasible.…”

Section: Nutrition Support In System Of Combat Casualty Carementioning

confidence: 99%

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Provision of Nutrition Support Therapies in the Recent Iraq and Afghanistan Conflicts

et al. 2014

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This article describes the experience of nutrition support practitioners, specifically dietitians, providing care to combat casualties. It provides a brief overview of dietitians' induction into armed service but focuses primarily on their role in providing nutrition support during the most recent conflicts in Iraq and Afghanistan. The current system of combat casualty care is discussed with specific emphasis on providing early and adequate nutrition support to U.S. combat casualties from injury, care in theater combat support hospitals (CSHs)/expeditionary medical support (EMEDs), and en route care during critical care air transport (CCAT) up to arrival at treatment facilities in the United States. The article also examines practices and challenges faced in the CSHs/EMEDs providing nutrition support to non-U.S. or coalition patients. Over the past decade in armed conflicts, dietitians, physicians, nurses, and other medical professionals have risen to challenges, have implemented systems, and continue working to optimize treatment across the spectrum of combat casualty care.

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“…Nutritional management in the deployed setting, in contrast, is more complicated, because of the restricted availability of certain products, in particular parenteral nutrition, the widespread use of damage control techniques, the rapid aeromedical evacuation of coalition personnel, and the limited treatment options available to host nation military personnel and local civilians following discharge from coalition medical treatment facilities. As a result, the commencement of feeding is often delayed, as shown by a prospective evaluation of American casualties evacuated from a combat support hospital in Iraq [3].…”

Section: Introductionmentioning

confidence: 99%

Nutritional Management of Critically Ill Trauma Patients in the Deployed Military Setting

Jansen¹,

Turner²,

Johnston

2011

J R Army Med Corps

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The role of nutritional support in critical illness is well established. This article reviews the nutritional management of military trauma patients in the deployed setting, which poses special challenges for the surgeon and intensivist. There is little direct evidence relating to the nutritional management of trauma patients in general, and military trauma patients in particular, but much of the evidence accrued in the civilian and non-trauma critical care setting can be extrapolated to military practice. There is strong consensus that feeding should be commenced as soon possible after injury. Enteral nutrition should be used in preference to parenteral nutrition whenever possible. If available, supplemental parenteral feeding can be considered if enteral delivery is insufficient. Gastrointestinal anastomoses and repairs, including those in the upper gastrointestinal tract, are not a contraindication to early enteral feeding. Intragastric delivery is more physiological and usually more convenient than postpyloric feeding, and thus the preferred route for the initiation of nutritional support. Feeding gastrostomies or jejunostomies should not be used for short-term nutritional support. Enteral feeding of patients with an open abdomen does not delay closure and may reduce the incidence of pneumonia, and enteral nutrition should be continued for scheduled relook surgery not involving hollow viscera or airway. Glutamine supplementation may improve outcome in trauma patients, but fish-oil containing feeds, while showing some promise, should be reserved for subgroups of patients with ARDS.group.bmj.com on June 22, 2015 -Published by

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Enteral Feeding Practices for U.S. Service Members in a Deployed Combat Support Hospital

Cited by 6 publications

References 19 publications

Nutrition Considerations for Burn Patients: Optimizing Recovery and Healing

Nutrition Considerations for Burn Patients: Optimizing Recovery and Healing

Provision of Nutrition Support Therapies in the Recent Iraq and Afghanistan Conflicts

Nutritional Management of Critically Ill Trauma Patients in the Deployed Military Setting

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