By Ms. Suzanne Ovel (Army Medicine)May 1, 2015
The best of the latest Madigan Army Medical Center research got some time in the spotlight here at Joint Base Lewis-McChord, Wash., on April 24 as Madigan residents, fellows and staff members presented their research findings to their peers as well as to academic and industry collaborators.
Research topics at the 18th Annual Madigan Research Day ranged from heat stroke complications to intensive care unit nutrition to adult autism needs. Although only 25 research projects were presented at the event, 100 were submitted for consideration. Overall, Madigan has more than 300 research projects currently ongoing and researchers here appear annually in about 400 research manuscripts, presentations, and abstracts.
"Research is really what provides tomorrow's approaches with respect to the care and readiness of the warfighter as well as care of service members' families," said Lt. Col. (Dr.) Richard Burney, chief of Madigan's Department of Clinical Investigation. "Medical research is embraced as a way to move health care forward."
At Madigan, this research ranges from the "bench science" of studying medicine at the molecular level to the more commonly performed clinical research. In the past year, researchers here have made significant contributions to areas such as infertility and sleep disorders, and just recently, Madigan joined with the University of Washington to study chronic pain treatments.
Those who presented at the Madigan Research Day also hope to have meaningful impacts result from their research. Capt. Natasha Pyzocha, a third-year resident at Madigan, presented a case study on a Soldier who suffered from multiple heat injuries and also tested positive for malignant hyperthermia, which is a specific and potentially fatal reaction to certain general anesthetics.
She said that people who experience multiple heat injuries also have a greater prevalence of malignant hyperthermia than the general population, which is why it is important for providers who work with the Soldier population (who may exert themselves in high temperatures more often) to be aware of the potential link between the two. Usually, people don't find out they have malignant hyperthermia until they're under anesthesia and undergoing potentially dangerous reactions, said Maj. Evan Trivette, Pyzocha's mentor for the study and the 3rd Brigade, 2nd Infantry Brigade Surgeon.
"Part of our research as well is potentially encouraging those who are interested to continue reading on the topic," said Pyzocha; this awareness may lead to more testing of Soldiers with multiple heat injuries for a predisposition to malignant hyperthermia, which could potentially lead to safer surgeries for them later on. Pyzocha also hopes that a long-term study may be done to identify if there is a direct link between heat injuries and malignant hyperthermia.
While Pyzocha dug deeper into one patient's care to inspire further research, a team of Madigan staff members conducted a retrospective study covering five years' of data to improve ICU outcomes.
Led by Mary McCarthy, the senior nurse scientist for Madigan's Center for Nursing Science and Clinical Inquiry, a research team delved into finding out just how many calories sedated patients need to heal optimally. While conventional wisdom may be that sedated patients need less calories, McCarthy and her team showed that sedated patients need just as many calories as their fellow conscious ICU patients. With bodies that are already severely stressed, under nourishing patients can have significant impacts.
"Critical ill patients are notoriously difficult to predict their nutritional needs," said McCarthy.
Trying to meet their nutritional needs without exceeding them is a fine line, she said. By using an indirect calorimetry tool, a computerized device that measures calories burned in real time, McCarthy's team more accurately measured the nutritional needs of patients on ventilators. Feeding sedated patients correctly could mean less time on the ventilator, less time in the ICU bed and therefore less muscle mass loss, less functional impairment and a greater ability to recover overall, McCarthy said.
Although the team has already presented their research at the national level, they also hope to be published in a medical journal to further the impact of their research, and to inspire future, more intensive studies.
With only 30 percent of hospitals nationwide using the calorimetry tool, the impact of changing the conventional wisdom on the correct feeding of sedated patients could be dramatic, according to Janet Fabling, one of the study's associate investigators and a nutrition support dietitian.
"It may be a game changer," Fabling said.