Eur. Burn J., Volume 2, Issue 3 (September 2021) – 8 articles

Treatment of patients with severe burn injuries is complex, relying on attentive fluid resuscitation, successful management of concomitant injuries, prompt wound assessment and closure, early rehabilitation, and compassionate psychosocial care. The goal of fluid resuscitation is to maintain organ perfusion at the lowest possible physiologic cost. This requires careful, hourly titration of the infusion rate to meet individual patient needs, and no more; the risks of over-resuscitation, such as compartment syndromes, are numerous and life-threatening. Recognizing runaway resuscitations and understanding how to employ adjuncts to crystalloid resuscitation are paramount to preventing morbidity and mortality. This article provides an update on fluid resuscitation techniques in burn patients, to include choosing the initial fluid infusion rate, using alternate endpoints of resuscitation, and responding to the difficult resuscitation. Full article

Burn patients are a unique population when considering strategies for ventilatory support. Frequent surgical operations, inhalation injury, pneumonia, and long durations of mechanical ventilation add to the challenging physiology of severe burn injury. We aim to provide a practical and evidence-based review of mechanical ventilation strategies for the critically ill burn patient that is tailored to the bedside clinician. Full article

Burn injuries can be life-threatening, thus standardized procedures are essential to ensure the best medical care is provided after injury. Therefore, burn care guidelines were created throughout the world. There are many similarities within the different burn guidelines, especially in basic burn care procedures. Taking a closer look, it becomes clear that there are also a lot of disparities within the guidelines. In this review the guidelines of the German Society of Burn Treatment (DGV), British Burn Association (BBA), European Burns Association (EBA), American Burn Association (ABA), Australian and New Zealand Burn Association (ANZBA), and the International Society for Burn Injuries (ISBI) are compared. The DGV-guidelines focus on pre-hospital treatment measures, intensive care treatment and acute wound therapy, whereas the BBA puts emphasis on infrastructure and staff qualification. The EBA created guidelines for medical practitioners and non-medical staff to standardize burn care in European countries with special focus on clear treatment recommendations and best infrastructural facilities. The ABA underlines the need for best qualified medical staff and ABLS- (Advanced Burn Life Support) standards. The ANZBA focuses on best treatment options including novel wound healing biotechnologies and post-burn return-to-function rehabilitation. In contrast to all other guidelines, the ISBI does not only deal with burn care in developed countries but also in resource-limited settings. Special focus lies on the discussion of ethical issues and cost-effectiveness. In this review, advantages and disadvantages of each guideline are discussed. These findings are supposed to help improving burn care procedures worldwide. Full article

Every year, thousands of soldiers and civilians succumb to burn wound trauma with highly unfavorable outcomes. We previously established a modified Walker-Mason rat scald model exhibiting a P. aeruginosa infection. Here we characterize deep partial- (DPT) and full-thickness (FT) burn wounds inoculated with Staphylococcus aureus. Male Sprague-Dawley rats (350–450 g) inflicted with 10% total body surface area burn inoculated with S. aureus (10^3–5 CFU/wound) were monitored over an 11-day period. S. aureus rapidly dominated the wound bed, with bacterial loads reaching at least 1 × 10⁹ CFU/g tissue in all wounds. Within 3 days, S. aureus biofilm formation occurred based on genetic transcripts and Giemsa staining of the tissue. S. aureus infection resulted in a slightly faster recruitment of neutrophils in FT wounds, which was related to necrotic neutrophils. The extent of the inflammatory response in S. aureus infected burn wounds correlated with elevated G-CSF, GM-CSF, GRO/KC and/or TNF-α levels, but a majority of pro- and anti-inflammatory cytokines (IL-1β, IL-6, IFN-γ, IL-10, and IL-13) were found to be suppressed, compared to burn-only controls. S. aureus infection resulted in dynamic changes in DAMPs, including elevated HMGB-1 and reduced levels of circulating hyaluronan within FT wounds. S. aureus also reduced complement C3 at all time points in DPT and FT wounds. These changes in DAMPs are believed to be correlated with burn severity and S. aureus specific bioburden. Collectively, this model showcases the evasiveness of S. aureus through dampening the immune response to flourish in the burn wound. Full article

Very few objective scar evaluations have been conducted with burn survivors, which limits our knowledge of the clinical recovery profile of hypertrophic scars (HSc) and donor site scars (D). The purpose of this study was to prospectively quantify the skin characteristics of post-burn HSc in different anatomical locations (D) and normal skin (N) using objective instrumentation. The skin characteristics of HSc, D, and N in 44 burn survivors were measured at 2, 3, 4, 5, 6, and 7 months post-burn using validated instrumentation: a high-frequency ultrasound (for thickness), Cutometer^® (for pliability), and Mexameter^® (for erythema and pigmentation). Up to five sites were assessed on the same participant, if their scar was located on the upper extremity (UE), lower extremity (LE), and trunk. A mixed model two-way analysis of variance was used to investigate the differences in means between sites at each time point and between time points at each site. The results revealed that the HSc sites were thicker than the D and N at all time points; the UE and trunk HSc were thicker than the LE HSc at 7 months post-burn; the pliability of the trunk HSc did not improve over time; and the UE HSc was more erythematous at 7 months, compared to other anatomical sites, whereas the D erythema decreased from 2 to 7 months. As clinicians have prioritized UE treatments due to their functional importance, this study provides objective measurements to further support this practice and encourages clinicians to also prioritize trunk HSc treatments after burn injuries. Full article

Over 95% of fire-related burns occur in low- and middle-income countries (LMICs), an important and frequently overlooked global health disparity, yet research is limited from LMICs on how survivors and their caregivers recover and successfully return to their pre-burn lives. This study examines the lived experiences of burn patients and caregivers, the most challenging aspects of their recoveries, and factors that have assisted in recovery. This qualitative study was conducted in KwaZulu-Natal, South Africa at a 900-bed district hospital. Participants (n = 35) included burn patients (n = 13) and caregivers (n = 22) after discharge. In-depth interviews addressed the recovery process after a burn injury. Data were coded using NVivo 12. Analysis revealed three major thematic categories. Coded data were triangulated to analyze caregiver and patient perspectives jointly. The participants’ lived experiences fell into three main categories: (1) psychological impacts of the burn, (2) enduring the transition into daily life, and (3) reflections on difficulties survivors face in returning for aftercare. The most notable discussions regarded stigma, difficulty accepting self-image, loss of relationships, returning to work, and barriers in receiving long-term aftercare at the hospital outpatient clinic. Patients and caregivers face significant adversities integrating into society. This study highlights areas in which burn survivors may benefit from assistance to inform future interventions and international health policy. Full article

The aim of this study was to describe the timing of venous thromboembolism diagnosis in patients with severe burns and determine the relationship between venous thromboembolism prophylaxis and venous thromboembolism development in a large trauma hospital. A retrospective cohort study over 10 years from 2009 to 2019 was conducted. Records of 226 patients with >20% total body surface area burns were surveyed, and 20 patients with symptoms suggestive of venous thromboembolism had a diagnosis of VTE confirmed on imaging. Enoxaparin was the most common primary thromboprophylaxis (85%, n = 192), followed by heparin (13.71%, n = 31) and sequential compression devices (0.88%, n = 2). Compared with patients who did not develop a venous thromboembolism, patients who developed a venous thromboembolism had a mean difference in time from admission to thromboprophylaxis prescription of 1.72 days (95% CI = −1.50 to 4.92, p > 0.05) and 10.51 days in those who developed a pulmonary embolus (mean difference = 10.51, 95% CI = 3.73 to 17.32, p = 0.0006). A threshold of 4 days was identified by which 96% of patients who never developed venous thromboembolism during admission were prescribed prophylaxis, compared with 32% of those who developed a pulmonary embolus. No bleeding or adverse events were recorded. Timely prescription of thromboprophylaxis in patients with severe burns is critical in reducing venous thromboembolism incidence. Avoidance of delay post injury is especially critical in preventing venous thromboembolism development. Guidelines on thromboprophylaxis must be considered on an individualised patient basis, considering likely surgical requirements and obesity. Full article

Burns are one of the most serious global public health challenges, and Nepal is no exception. This study aims to present national and local-level data regarding burn injuries within Nepal. Similarly, this study shows how the trained rural first responders respond to burn injuries at the community level, with an example from the Dhading district of Nepal. Police and Emergency Medical Services (EMS) records were used to describe the national and community-level burn injury patterns. The most common cause of burns was found to be household fire, mainly from cooking. The burn cases are distributed across all ages; however, young age group comprises a notable proportion. Victims who were injured but were still able to move primarily accessed emergency health services by walking to the closest facility. Mainly, burn victims received a dressing and cold sponging service at the primary health center. This study described the Emergency Medical Services (EMS) in detail and identified that appropriate training to the community people to respond the burns injuries minimizes the severity of the cases. Lessons learned from this project can be utilized to implement emergency burn injury management for the public and local responders in other rural areas at minimum costs. We recommend establishing burn care instruction in all rural/remote villages and health care centers in Nepal. Full article