Cardiovascular and respiratory responses to physical activity and heat stress in burn survivors

About This Grant

PROJECT SUMMARY/ABSTRACT Despite being healed from their burn injuries, burn survivors have impaired thermoregulation, decreased pulmonary function with accompanying dyspnea at rest and during exercise, a greater incidence of cardiovascular disease, and higher mortality rates. Regarding the former, grafted skin does not appropriately dissipate heat, resulting in exaggerated increases in core temperature during physical activity in this population. Skin wetting of just the grafted sites blunts the exaggerated increases in core temperature, and perhaps the accompanying increased cardiac and pulmonary stress, though the latter has not been experimentally verified. Therefore, we aim to investigate the efficacy of whole-body skin wetting to mitigate otherwise heightened indices of cardiac and pulmonary stress during physical activity in the heat in well-healed burn survivors. As a secondary exploratory aim to continue to explore the consequences of a severe burn injury on long term health, we aim to investigate the possible effects of an inhalation injury, time on a ventilator, and/or significant torso burns and associated skin scarring on detailed respiratory function and mechanics at rest and during physical activity in well-healed burn survivors. The overarching goal of the proposed work is to identify physiological barriers, and assess a potential mitigation strategy, that likely dissuade burn survivors from achieving the recommended levels of physical activity necessary for their cardio-metabolic health, thereby predisposing burn survivors to the aforementioned greater mortality risk. The expected outcomes from this work will have a direct impact on burn survivors and their caretakers by evaluating the efficacy of a practical cooling strategy that has the potential to decrease cardiac stress and reduce the severity of dyspnea thereby improving exercise “comfortability” in burn survivors. Secondly, establishing a foundation of the effects of a severe burn injury on detailed respiratory mechanics is necessary to develop future studies where interventions (i.e., inspiratory muscle training) can be tested to improve the mechanics of breathing in this population. This research directly supports the mission of the NIH in that we will uncover mechanistic physiological findings from human participants with the goal of translating those findings to guide individuals and caregivers on how to increase exercise tolerance in burn survivors thereby improving their quality of life. To ensure that this study is designed to maximize clinical relevance and my scientific training, I assembled a strong interdisciplinary clinical research/mentoring team consisting of expert integrative physiologists, physician- scientists, and a biostatistician. My primary goals during this fellowship are to complete the proposed project, master several technical skills (i.e., echocardiography), improve my ability to obtain future extramural research funding, and publish research findings in peer-reviewed medical and physiology journals.