Early Enteral Nutrition in Aeromedically Evacuated Critically Ill/Injured Patients With a Resultant Validation Algorithm for the Theater Validating Flight Surgeon.

Autor: Butler WP; 711th Human Performance Wing, USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA., Woody SK; 711th Human Performance Wing, USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA., Huffman SL; 711th Human Performance Wing, USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA., Harding CJ; 711th Human Performance Wing, USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA., Brown KN; 711th Human Performance Wing, USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA., Smith DE; 711th Human Performance Wing, USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA., Noe TC; 711th Human Performance Wing, USAF School of Aerospace Medicine, Wright-Patterson Air Force Base, OH 45433, USA., Gholson AD; 59th Medical Wing, En Route Critical Care Pilot Unit, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, TX 78236, USA.
Jazyk: angličtina
Zdroj: Military medicine [Mil Med] 2023 Nov 08; Vol. 188 (Suppl 6), pp. 61-66.
DOI: 10.1093/milmed/usad030
Abstrakt: Introduction: Early enteral feeding in critically ill/injured patients promotes 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.
Materials and Methods: This retrospective descriptive study employed AE enteral nutrition (EN) data (2007-2019) collected from patients who were U.S. citizens and mechanically ventilated. The dataset was created from the En Route Critical Care, Transportation Command Regulating and Command and Control Evacuation System, and Theater Medical Data Store databases. Comparisons were performed between patients extracted and patients not extracted, patients treated with EN and patients treated without EN, and within the EN group, between AE Fed and AE Withheld. The impact of the nutrition support in the Joint Trauma System Clinical Practice Guidelines (CPG) was assessed using the 'before' and 'after' methodology.
Results: An uptick in feeding rates was found after the 2010 CPG, 15% → 17%. With the next two CPG iterations, rates rose significantly, 17% → 48%. Concurrently, AE feeding holds rose significantly, 10% → 24%, later dropping to 17%. In addition, little difference was found between those patients not enterally fed preflight and those enterally fed 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 study's patients were not fed, and 18% of those that were fed had feeding withheld for AE.
Conclusions: It appeared that the Clinical Practice Guidelines (CPGs) reinforced the value of feeding, but may well have sensitized to the threat of aspiration. It also appeared that early enteral feeding was underprescribed and AE feeding withholds were overprescribed. Consequently, an algorithm was devised for the Theater Validating Flight Surgeon, bearing in mind relevant preflight/inflight/clinical issues, with prescriptions designed to boost feeding, diminish AE withholding, and minimize complications.
(© The Association of Military Surgeons of the United States 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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