Enteral nutrition by a forward surgical team in Afghanistan

Objectives: The modern practice of trauma surgery is a global physiologic approach to caring for the injured patient. Included in that approach is consideration of the traumatized patient's nutritional needs and implementing early enteral feeding. This is routine practice in the United States but logistically impractical when using commercial enteral feeding formulas in the austere environment of a Forward Operating Base in Afghanistan. Methods: At a Forward Operating Base in southern Afghanistan, injured patients who were not expected to be taking a regular diet by 72 hours after injury are started on early enteral feedings. This is through nasogastric, gastrostomy, or jejunostomy tube, using formulas of pureed food available in the theater from local sources and supplemented with ingredients from US Army Meals-Ready-to-Eat. Preparation, nutritional calculation, and delivery are discussed. Results: The injured soldiers and Afghan nationals tolerated early enteral feedings with no complications encountered related to the feeding portal, infusion, or ingredients. Conclusions: Early enteral feeding of traumatized patients in the far forward environment of southeastern Afghanistan is practical with the use of ingredients found locally in-theater.