A continuing goal of the Miami Memorial Burn Center is to improve the survival and recovery of burn patients. The specialty has steadily progressed in this regard, but there is much need for further advancement. There are many clinical issues yet to be completely understood or solved. They include fluid resuscitation, infection, antibiotic usage, wound coverage, nutrition, and the incidence of deep vein thrombosis in burn patients. Controversy remains regarding the best method to fluid-resuscitate patients with major injuries and new strategies to reduce the inflammatory response to a burn are being studied to help save lives. A burn is not a solitary injury, but rather affects the entire family. How a patient appears to others and to themselves greatly affects the recovery time and effort.
Most 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 define a baseline and expected degree of depression so that an early and effective intervention can be made against this debilitating response.
The Miami Burn Center has evaluated the effects of intravenous Vitamin C (ascorbic acid) on Burn Injury Resuscitation. It is thought that the use of high dose Vitamin C lowers intravenous fluid requirement per percent total body surface area burn while maintaining adequate urine output. The decreased fluid requirements needed for resuscitation decreases the rates of abdominal and extremity compartment syndrome and thus decreases the need for decompressive laparotomies and extremity fasciotomies. There is also a possibility to decrease the number of mechanical ventilator days in patients with clinical/radiographic pulmonary edema and lower systemic infection rates.
The resistance of bacteria to antibiotics is a severe clinical issue with no immediate solution in sight. Newer antibiotics have allowed bacteria to become resistant to additional medications. Projects are underway to evaluate the efficacy of interventions to combat infection with multiple drug resistant Acinetobacter baumannii and those associated with central venous and foley catheters.
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. The Burn Center is evaluating new products designed to promote wound healing and continues to evaluate topical antimicrobial agents in order to optimize the prevention of wound infections as well as the comfort of the patients who require them.
Nutrition is understood better now 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 completely understood.
Presently there is insufficient 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 is to determine if prophylaxis is necessary.
Several multicenter studies include the Miami Burn Center patients in order to garner large patient groups and diverse geographic locations. Not all studies require multiple clinical sites, thus the 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.