The Uppsala Burn Research Program

Principal investigator: Fredrik Huss

A burn injury is a good model for understanding the response to a severe trauma, viewed from a short as well as a long perspective. The disastrous experience of being afflicted with an extensive burn injury affects all main integrating systems in the body (i.e. nervous, endocrine and immune). The acute phase is characterized by a relatively intense and rapidly developing physiologic inflammatory response, not only in the immediate vicinity of injured tissue, but also in a generalized syndrome of systemic inflammation, which in general is proportional to the magnitude of injury. In the most severe cases it can lead to circulatory shock, organ dysfunction, and death.

It is quite obvious that burn care is heavily multifactorial and multiprofessional, spanning from simple wound care to advanced tissue engineering/tissue culture, from intensive care to psycho-social support.

The Uppsala Burn Research Program is an umbrella for clinical research on burns and outcome after burns and is divided into modules containing the main parts of the treatment processes for burns:

  • Resilience and Vulnerability
  • Anaesthesiology and Intensive Care
  • Surgery / wound healing
  • Prevention
  • Rehabilitation
  • Family perspective
  • Patient satisfaction

A few of the ongoing projects are here described

Nosocomial infections caused by S. aureus in burn patients

Background: Staphyloccocus aureus is a bacterium that normally occurs in about 30% of the population and colonizes nose, mouth, armpit and groin, without necessarily causing infection.

Burn patients represents essentially a normal population but in which the burns themselves is a breeding ground for the establishment of infections and therefore a secondary influence on the immunological defense. Sepsis and serious wound infections due to S. aureus is very common in burn patients. According to other studies 50-60% of patients with major burns suffer infections caused by S. aureus.

Whether the infection is nosocomial or caused by the patient's own normal flora has never been investigated until now.

Artificial intelligence and computer assessment for diagnostics and clinical decision making: Applications for assessment of burns and skin lesions

The aim is to investigate the use of artificial intelligence (AI), machine learning (ML) and image processing in order to generate both a decision and also an opportunity to automate decision making.

The importance of nutrition after minor burns

Purpose: To study the importance of nutrition after minor burns (< 20% of the body area).

Hypothesis: Adequate nutritional status (adequate energy and protein intake as well as weight stability) after a minor burn leads to better results (faster wound healing, fewer infections).

Significance: The importance of nutrition after minor burns is relatively unexplored. By identifying energy and protein needs, we as clinicians can get guidance on how to better treat this patient group in the future. Since nutritional status and frequency of malnutrition after minor burns are poorly studied, results from this study can provide guidance on whether nutritional screening can be a future tool for identifying patients in need of continued nutritional care also after minor burns.

Resuscitation the first 24 hours. The use of a protocol to improve the adherence to a fluid treatment algorithm

An algorithm for fluid resuscitation has been developed and the adherence and outcome of the algorithm is studied.

Pain in ICU patients, subjective aspects and objective parameters

A study of objective parameters correlating to the patients’ description of pain-experiences to develop a protocol to use objective parameters in sedated patients for pain treatment.

Hydrogen peroxide, and other markers of severe sepsis and septic shock

The purpose of the study is to measure hydrogen peroxide, glutathione and other biomarkers in patients with severe sepsis and septic shock and significant burns. The concentrations of hydrogen peroxide and glutathione will be measured over time for several days to examine the variability of these markers and how these markers is influenced by usual treatment. Inflammatory mediators in the blood will also be analyzed. Correlation with SOFA and SAPS 3 scores, which are clinical markers of severity of the infection and 28 day mortality after onset of illness will be investigated. The septic patients’ biomarkers will be compared with the burn patients’ in order to investigate any differences between SIRS±sepsis and burns.

Epidemiology

Each year over 300 000 people die worldwide, and about 90% of burns occur in countries with low and middle incomes. The morbidity after large burns is often considerable and commonly associated with reduced quality of life. Older Scandinavian investigations have indicated that about 0.4% of the population seek medical care for burns each year. With the current population in Sweden this would extrapolate to about 38 000 burns treated each year. In several projects and from different aspects are we investigating the epidemiology of fire-related injuries and deaths in Sweden.

Intestinal flora in burn patients

A study of the intestinal flora, the presence of resistant intestinal bacteria, and the effect of faecestransplantation in patients with severe burns.

This study examines

  1. the intestinal microflora composition and the presence of resistant intestinal bacteria in patients who admitted to our burn center
  2. the intestinal flora and occurrence of resistant bacteria changes during hospitalization
  3. the relationship between the given antibiotic treatment and the intestinal flora as well as the risk of resistance development
  4. whether faecestransplantation performed after completion of treatment has a beneficial effect on the patient's intestinal flora and risk of carriage of resistant bacteria in the longer term.

Members of the program during 2018

Morten Kildal, MD, PhD, Associate Professor, Department of Surgical Sciences, Plastic Surgery, and the Burn Center Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital
Fredrik Huss, MD, PhD, Associate Professor Department of Surgical Sciences, Plastic Surgery and the Burn Center, Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital
Caisa Öster, RN, PhD, Senior Lecturer, Department of Neuroscience, Psychiatry
Josefin Sveen, PhD, Department of Neuroscience, Psychiatry
Filip Fredén, MD, PhD, Dept of Surgical Sciences, Anesthesiology and Intensive Care and the Burn Center, Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital
Eva Tano, PhD, Microbiologist, Department of Medical Sciences, Section of Clinical Bacteriologyx
Aida Pleasan, MD, PhD Department of Surgical Sciences, Anesthesiology and Intensive Care
Miklós Lipcsey, MD, PhD Department of Surgical Sciences, Anesthesiology and Intensive Care
Mia Furebring, MD, PhD Department of Medical Sciences, Section of Infectious Diseases
Hanna Monteélin, MD, PhD-student Department of Medical Sciences, Section of Infectious Diseases
Ilaria Tocco-Tussardi, MD Burn Center, Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital
Marie Lindblad, RN, Research nurse Burn Center, Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital
Thomas Tängdén, MD, PhD Department of Medical Sciences, Section of Infectious Diseases
Anders Jonsson, Bsc, Div of Risk Management, Department of Environmental and Life Sciences, Karlstad University
Jian Fransén, MD, PhD-student. Dept of Surgery, Västerås Hospital and Department of Surgical Sciences, Plastic Surgery
Josefin Dimander, Nutritionist, PhD-student, the Burn Center Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital

Authorities supporting work / Financing

MSB (Myndigheten för samhällsskydd och beredskap)
Uppsala Universitetssjukhus (ALF)
Det svenska Läkaresällskapet (SLS)
Personskador till följd av bränder