|Interdisciplinary Team Develops Guidelines for Treating Severely
Consortium Publishes First Protocol, Plans Seven More
If someone is injured in an automobile collision or is severely burned, emergency
room physicians across the country would probably take similar steps to stabilize
each condition. But subsequent treatment in the intensive care unit or operating
room is less well established and may vary significantly.
That is likely to change based on the work of an interdisciplinary team of dozens
of scientists and physicians funded by the National Institute of General Medical
Sciences (NIGMS), part of the National Institutes of Health (NIH). Drawing from
the best available evidence, the team is developing a series of standard procedures
for the care of severely injured patients. The guidelines will describe how to
implement the most successful treatment protocols in the clinic and will include
summaries of each procedure ready to print on 3-by-5 index cards for quick bedside
The team’s first article — on mechanical ventilation — appeared
in the September 2005 issue of the Journal of Trauma: Injury, Infection,
and Critical Care. Planned future topics will cover resuscitation, prevention
and treatment of venous blood clots, diagnosis of ventilator-associated pneumonia,
blood sugar control, nutritional support, transfusion thresholds, and sedation.
The team chose to cover aspects of care for which practices vary the most and
those that have the greatest potential to influence patient outcomes.
The scientific team is part of a collaborative, NIGMS-supported initiative called
the Inflammation and Host Response to Injury “glue grant” program. Glue grants
bring together scientists with diverse expertise to address major biomedical
questions that are beyond the scope of any one research group — in this
case, to uncover why patients who experience comparable traumatic injuries can
have dramatically different outcomes. This project was launched in 2001 with
a 5-year award totaling $37 million.
"This program shows how partnerships between clinical and basic researchers
can speed the pace of improving medical practices," said NIH Director Elias A.
Zerhouni, M.D. “Combining cutting-edge basic science tools with clinical know-how
is a powerful formula for solving complex medical problems.”
The outcomes for trauma and burn patients often depend on the strength of their
inflammatory response to their injury. Inflammation helps the healing process
in many cases, but an excessive response can lead to multiple organ failure,
a common cause of death following a traumatic injury.
“Thanks to the increased skills of paramedics and first responders, more and
more severely injured patients are making it to the emergency room,” said Ronald
Maier, M.D., director of the team’s clinical group and surgeon-in-chief at Harborview
Medical Center in Seattle. But with this change come new challenges. “What we’re
now faced with is treating the patient’s own aberrant response to the injury,
which can cause far more damage than the injury itself.”
While the magnitude of the injury and the quality of care affect the inflammatory
response, the patient’s genetic make-up is also thought to contribute. To pinpoint
the relevant genetic factors, the researchers are looking for gene activity patterns
that correlate with specific outcomes. All nine of the clinical institutions
participating in the project are adopting the standard practices, which will
make these genetic patterns easier to discern.
“Establishing standard treatment procedures is an important first step in improving
patient care,” said NIGMS Director Jeremy M. Berg, Ph.D. “But we expect the real
breakthrough to come when genetic data from the project helps physicians tailor
treatments for each critically injured patient.”
While the inflammation glue grant focuses on the care of patients once at the
hospital, a complementary NIH program, the Resuscitation Outcomes Consortium,
aims to improve patient survival before an injured person reaches the emergency
|The first published protocol
summarized to fit on the front and back sides of an index card. To view
a larger image of the protocol, please click here.
To schedule an interview with Dr. Berg contact the NIGMS Office of Communications
and Public Liaison at 301-496-7301. To schedule an interview with Dr. Maier contact
Susan Gregg-Hanson of Harborview Medical Center at 206-731-4097 or firstname.lastname@example.org.
For more information about the Inflammation and Host Response to Injury glue
grant, see http://www.gluegrant.org/.
For general information on glue grants, go to http://www.nigms.nih.gov/Initiatives/Collaborative/GlueGrants/.
For more information on the Resuscitation Outcomes Consortium, see https://roc.uwctc.org/tiki/tiki-index.php.
a component of the National Institutes of Health, supports basic biomedical
research that is the foundation for advances in disease diagnosis, treatment,
The National Institutes of Health (NIH) — The Nation's Medical Research
Agency — includes 27 Institutes and Centers and is a component of
the U.S. Department of Health and Human Services. It is the primary federal
agency for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both common
and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.