"You know, it's a funny thing; the more I practice, the luckier I get."

Lee Trevino






Contents © 2004-2011 Massachusetts
General Hospital



One of the main goals of this NIH-funded research program, Inflammation and the Host Response to Injury, is to make our results available to the general public and investigators who are not direct participants. Information accessible via this web site includes descriptions of standardized laboratory and clinical procedures. Analytical protocols describe experimental procedures such as isolating RNA and profiling gene expression in clinical samples via microarray technology. Clinical protocols, describing standardized procedures for collecting blood, patient data, and managing the care of injured patients, are also freely available. Protocols are posted on this web site shortly after being validated and certified by the participating investigators. A brief description of each numbered protocol is listed below.

Protocols on this page beginning with TR are Trauma protocols and those beginning with BR are Burn protocols.

You must be a Consortium member to view the full text of the protocols. Consortium members may click here to go to the login page. Once you are logged in you may view the protocols available for your group.


Trauma Study Eligibility

The purpose of the trauma clinical core is to study the incidence and consequences of severe trauma in critically injured patients at significant risk for an Intensive Care Unit stay and subsequent organ dysfunction. Data from the trauma study are used to support research by our funded participating investigators to study the extent of tissue damage, physiological response to injury, and the humoral, proteomic and genomic factors that mediate the host response. These data also help better understand the individual, age-related, gender-specific and other population-specific responses to traumatic injury, including normal or pathophysiologic changes after injury and factors or therapies that influence stabilization and recovery. The patients enrolled in the sampling study serve as a subset of the patients enrolled in our epidemiology study. This investigator-driven study design provides insights into an entire population and their clinical course and thus allows identification of sub-populations for research and therapeutic interventions. Our investigators plan to expand the use of the data and make the data available for further research and development by the greater research community.

[revised May 2004]


Trauma resuscitation flowchart
Trauma Resuscitation Flowchart

TR1 - Trauma Resuscitation

The goal of this protocol is to guide consistent resuscitation efforts. Developed by the best evidence-based data available, this protocol progresses through a tiered approach to resuscitation, beginning with the widely accepted Advanced Trauma Life Support protocol. Since the majority of severe trauma patients present in shock due to excessive hemorrhaging, these patients require crystalloid administration and blood transfusion. The protocol aims for an optimal hematocrit of 30 during the acute resuscitation phase. If volume repletion efforts are inadequate to restore hemodynamic stability and hypovolemia is considered unlikely, a pulmonary artery catheter and/or echocardiogram may help rule out cardiac dysfunction as the etiology. Data from the pulmonary artery catheter are used to maintain an adequate, but not supranormal, cardiac index and oxygen delivery.


[Click on the flowchart for a popup window with a larger view]


[revised May 2004]



TR2 - Mechanical Ventilation

This protocol promotes a low tidal volume, lung-protective strategy for ventilating patients meeting the criteria for acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). To achieve adequate oxygenation, variable positive end-expiratory pressure (PEEP) and inspired oxygen (FiO2) is left to physician discretion, but the FiO2 to PEEP ratio should be less than or equal to 5. If arterial oxygenation is not within the target range, then either FiO2 or PEEP should be adjusted, after which oxygenation should be reassessed within 15 minutes and subsequent adjustments made if necessary. The mode of mechanical ventilation is left to physician discretion; however, once patients are ready to wean, a daily trial of spontaneous breathing offers the best chances for early extubation. If the patient cannot be weaned from mechanical ventilation, the protocol recommends gradual reduction in breathing support, at the physician's discretion. In these patients, subsequent cycles of spontaneous breathing, weaning, and breathing support overnight for rest should be continued daily until the patient is breathing independently.

[revised May 2004]


Ventilator-associated pneumonia flow chart
Ventilator-Associated Pneumonia Flowchart

TR3 - Ventilator-Associated Pneumonia

This protocol addresses ventilator-associated pneumonia (VAP). Prevention of VAP is best accomplished through adequate hand washing, inclining the patient 30 degrees or more, avoiding gastric overdistention, and maintaining the patient's oral hygiene. Various clinical criteria are used to diagnose VAP, but none is optimal. Patients with a threshold clinical pulmonary infection score (CPIS) greater than 6 should be evaluated for pneumonia. Quantitative endotracheal aspiration cannot be considered sensitive or specific enough to accurately diagnose VAP. In contrast, quantitative sampling by bronchoalveolar lavage (BAL) or protected-brush specimens of the lower respiratory tract are useful in establishing the diagnosis of VAP. It is critical that treatment of suspected VAP begin with early, empiric therapy targeted to common organisms, as defined by the local antibiogram for the unit in question. Inadequate antibiotic coverage significantly increases mortality in these patients. If infection is not found, antibiotic therapy should be halted and changes in antibiotic therapy should be based on results of cultures obtained from the lower respiratory tract to prevent superinfection and secondary pneumonia from resistant organisms.


[Click on the flowchart for a popup window with a larger view]

[revised May 2004]


TR4 - ICU Insulin Infusion Guidelines (final text to be announced)

[revised September 2004]


TR5 - Transfusion Flowchart (final text to be announced)

[revised September 2004]


TR6 - VTE Prophylaxis Flowchart (final text to be announced)

[revised September 2004]


TR7 - Sedation/Analgesia Flowchart (final text to be announced)

[revised September 2004]


TR8 - Antibiotics Flowchart (final text to be announced)

[revised September 2004]


Trauma Epidemiological Study


Trauma Blood Sampling Protocol

[revised February 2004]


Trauma Tissue Sampling Protocol

[revised February 2004]


Burn Study Eligibility Inclusion/Exclusion Criteria

The purpose of the burn clinical core is to study the incidence and consequences of burn injury in patients at significant risk for an Intensive Care Unit stay and organ dysfunction. Data from the burn study are used to support research by our funded participating investigators to study the extent of tissue damage, physiological response to burn injury, and the humoral, proteomic and genomic factors that mediate the host response. These data also help better understand the individual, age-related, gender-specific and other population-specific responses to burn injury, including normal or pathophysiologic changes after injury and factors or therapies that influence stabilization and recovery. Our investigators plan to expand the use of the data and make the data available for further research and development by the greater research community.

[revised May 2004]


B1 - Burn Protocol

[revised March 2002]


B1.03 - Evaluation of RNA Yields from Human Skin, Adipose Tissue and Muscle

[revised December 2002]


B2 - Enrollment Form

[revised January 2002]


B3 - Daily Data Form

[revised January 2002]


Burn Specimen Collection

[revised March 2004]


Burn Speciment Shipment

[revised March 2004]


BR - Burn Care Guidelines

Treatment variables have been standardized according to American Burn Association guidelines for the provision of acute burn care. A set of guidelines has been developed into a single document for burn resuscitation, diagnosis of inhalation injury, burn wound management, management of acute lung injury, perioperative antibiotic prophylaxis, diagnosis and management of ventilator-associated pneumonia, central line management, venous thromboembolism prophylaxis, and nutrition.

[revised September 2004]


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