Research

A continuing goal of the Burn Center is to improve the recovery and survival of burn patients. The specialty has steadily progressed in this regard, but there is always room for further advancement. A burn is not a solitary injury, but rather affects the entire family.  How patients appear to others and to themselves affects a large part of the recovery time and effort. The manner in which patients handle an injury tests their premorbid mental stability, it does not temper and strengthen it.

All burn patients are depressed at one time or another, but the general extent and common consequences have not been studied. Even the instructions to a patient and their family can be misinterpreted as a result of patient and family depression. To help define the psychological issues of burn patients, a study has been designed to:

1. determine the prevalence of depression and depressive symptoms in acutely injured patients,
2. determine if the presence of depressive symptoms are associated with an increased odds of high-risk behavior, and
3. is there an increased prevalence of depression or depressive symptoms in specific demographic categories.

This study should define a baseline and expected degree of depression so that an early and effective intervention can be made against this debilitating response.

There are old clinical issues yet to be completely understood or solved. These include fluid resuscitation, infection, antibiotic usage, wound coverage, nutrition, and the incidence of deep vein thrombosis in burn patients. Controversy remains as how to best fluid-resuscitate patients with major injuries. The Effect of High Dose Versus Low Dose Intravenous Vitamin C (ascorbic acid) on Burn Injury Resuscitation is a multi-center, double blind, prospective, and randomized study. It was designed to evaluate the effects of high dose vitamin C on the resuscitative fluid needs and fluid resuscitation complications of burn injured patients. The use of vitamin C may lower intravenous fluid requirement per percent total body surface area burn in a high dose vitamin C group compared to a control group while maintaining adequate urine output.  If this is found to be true, it could also prove to decreased the rates of compartment syndrome, extremity compartment syndrome, decompressive laparotomy, and extremity fasciotomies in the high dose vitamin C group. There is also a possibility to decrease the number of mechanical ventilator days in patients with clinical/radiographic pulmonary edema in the vitamin C group compared to the control group. Additionally, patients receiving the vitamin C will be watched for lower complication and infection rates compared to the control group.

The resistance of bacteria to antibiotics is a severe clinical issue with no immediate solution in sight. Newer antibiotics have only allowed bacteria to become resistant to additional medications. A project is underway to evaluate the efficacy of interventions of infection with multiple drug resistant Acinetobacter baumannii. The goal is to determine:

1. the rate of clinical cure with our current treatment strategy,
2. the incidence of drug resistance, and
3. the mortality rate associated with Acinetobacter baumanii infection.

The colonization of the gastrointestinal tract of critical burn and trauma patients has a profound effect on their clinical course. Therefore, a study is being carried out to look at the effect of antimicrobial therapy on antibiotic resistant micro-organisms in a trauma population. The study’s goal is to determine the incidence of colonization of the gastrointestinal tract by antibiotic resistant micro-organisms in the trauma population of our institution at the time of admission, during the period of intensive care, and following intensive care.

There is yet to be a better substitute for wound coverage than a patient’s own skin. To find an equivalent substitute is one of several holy grails of burn care.

Nutrition is understood better than in the past, but it is now known that more calories is not necessarily better for a patient. Today it is generally felt using the gastrointestinal tract is better than intravenous feeding. Why this is so and what the components of the feedings should be is not fully understood.

Presently there are no specific data available regarding the use of pharmacologic Deep Vein Thrombosis Prophylaxis in severely burned patients. The effects of these anticoagulants may be significantly attenuated by the hypercoagulable state resulting in inadequate thrombosis inhibition. The goal of the study is determine if prophylaxis is necessary.

Several multicenter studies include the UM/JM Burn Center patients in order to garner large patient groups and diverse geographic locations. Not all studies require multiple clinical sites, thus the UM/JM Burn Center has specific studies about antibiotics, proper fluid resuscitation solutions and techniques, and proper oral diets that enhance the recovery of patients. In all there are over twenty research protocols in progress at the Burn Center. These projects reflect the clinical, basic science, and psychological science interests of the Burn Center Faculty. They are collectively being done on the clinical wards, in the basic science laboratory, the operating rooms, the intensive care units, and the trauma center resuscitation area. The results of all of the studies will have an influence on the care and recovery of burn victims. The diversity of the patients and the research studies allows the Burn Center staff to be participants and designers of the studies. Everyone contributes; it is a true team approach to research.