Combat Trauma & Burn Research

OVERARCHING OBJECTIVE

The focus of this Program Area is to design and conduct clinical studies in combat trauma patients (including those with burns) in an effort to improve immediate and long term outcomes in critically injured.

This group will identify and prioritize various issues relevant to the care of combat wounded and strive to optimize in-hospital care. Trials will be lead and conducted by in-house investigators in collaboration with outside expertise when needed.

BACKGROUND

In burn intensive care units (ICUs) across the country, many different strategies are utilized to optimize treatment of the severely injured.

The conventional approach in most community intensive care units remains resuscitation, excision and grafting of burn wound for closure if present, and critical care support of the response to severe injury as this occurs.

Many treatments are considered standard throughout the world to be associated with the best possible outcomes, however, often therapies are derived that may further improve these outcomes.

These novel therapies require study under controlled conditions to validate efficacy.

RESEARCH ACTIVITY

Among the studies being conducted are:

Biomarkers for detection and characterization of organ failure to determine if they can identify those trauma/burn patients who will go on to develop Multi-Organ Dysfunction (MOD). Any such markers would help to triage casualties based on future development of MODs and enable earlier intervention/more aggressive treatment of those who develop MODs.

Smart ventilators offer an opportunity to determine if increased complexity in breathing patterns in intubated patients identifies those with improving respiratory health. The goal is a hardware/software ventilator interface that can identify those intubated patients ready for extubation resulting in reduced morbidity and mortality from ventilator complications.

The BEST (Burn center Evaluation of Standard Therapies) Ventilator Mode Study will compare high frequency percussive ventilation (HFPV) to conventional ventilation to determine the optimal ventilator strategy in severely burned casualties.

Coagulation and Inflammation to determine the effects of blood/product administration on shock and anticoagulation as measured by soluble blood proteins involved in hemostasis to reduce deaths from hemorrhage on the battlefield.

There are multi-center human clinical studies sponsored by other organizations such as the American Burn Association that we participate in.

We also have technical oversight of research being done in theater through the Joint Combat Casualty Research Team.

FUTURE DIRECTION

Draw on the considerable expertise in the Burn Center to engage in a comprehensive research program focused on improving outcomes in critically injured Soldiers through controlled administration of innovative therapies such as:

• Improved therapeutics and medical management strategies for burns and smoke inhalation
• Pharmaceuticals (conventional and biotechnological) to include resuscitation fluids, antibiotics, analgesics, and agents to control post-traumatic cell and organ injury resulting from burns and lung injury.
• Improved dressings for the treatment of autogenous donor sites
• Nutrition in the severely burned

PUBLICATIONS

1.) Lundy JB, Hetz K, Chung KK, Renz EM, White CE, King BT, Huzar T, Wolf SE, Balckbourne LH. Outcomes with the use of recombinant human erythropoietin in critically ill patients. Am Surg. 2010; 76(9):951-6

2.) Chung K, Wolf S, Renz E, Allan P, Aden J, Merrill G, Shelhammer M, King B, White C, Bell D, Schwacha M, Wanek S, Wade C, Holcomb J, Blackbourne L, Cancio L. High Frequency Percussive Ventilation and Low Tidal Volume Ventilation in Burns: A Randomized Controlled Trial. Crit Care Med 2010;38:1970-1977. Epub 2010 Jul 15.

3.) White CE, Batchinsky AI, Necsoiu C. Nguyen R, Walker KP, Chung KK, Wolf SE, Cancio LC. Lower Inter-breath Interval Complexity Is Associated with Extuabtion Failure in Mechanically Ventilated Patients during Spontaneous Breathing Tirals. J Trauma. 2010;68:1310-6

4.) Lundy J, Lairet K, Chung K, Renz E. Routine laboratory monitoring for LMWH prophylaxis in burns? Not so fast! Journal of Burn Care and Research 2011;32:e155.

5.) Chung K, Stewart I, Gisler C, Simmons J, Aden J, Tilley M, Cotant C, White C, Wolf S, Renz E. The Acute Kidney Injury Network (AKIN) Criteria Applied in Burns. J Burn Care Res 2011. (in press)

6.) Beth BA, Doty KA, Chung KK, Aden JK, Wade CE, Wolf SE. Determination of resting energy expenditure after severe burn. Journal of Burn Care & Research 2012. (in press)

7.) Stewart I, Tilley M, Cotant C, Aden J, Gisler C, McCorcle J, Renz E, Chung K. Acute kidney injury is independently associated with morbidity and mortality in military personnel burned in Iraq and Afghanistan. CJASN 2011. (in press)