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Introduction: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes., Methods: The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported., Results: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis., Conclusion: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients., Competing Interests: Declaration of Competing Interest Kevin Chung is Chief Medical Officer for SeaStar Medical, Denver, Colorado. No other author has declared a conflict of interest related to the publication., (Copyright © 2023 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Background: Cooling thermal burns with running water is a recommended first aid intervention. However, guidance on the ideal duration of cooling remains controversial and inconsistent across organisations., Aim: To perform a systematic review of the evidence for the question; Among adults and children with thermal burn, does active cooling using running water as an immediate first aid intervention for 20 min or more, compared with active cooling using running water for any other duration, change the outcomes of burn size, burn depth, pain, adverse outcome (hypothermia) or complications?, Method: We searched Medline, Embase, Cochrane Database of Systematic Reviews and used ROBINS-I to assess for risk of bias. We used Grading of Recommendations, Assessment, Development and Evaluation methodology for determining the certainty of evidence. We included all studies that compared the selected outcomes of the duration of cooling of thermal burns with water in all patient ages. (PROSPERO registration number: CRD42021180665). From 560 screened references, we included four observational studies. In these studies, 48% of burns were cooled for 20 min or more. We found no benefit for a duration of 20 min or more of cooling when compared with less than 20 min of cooling for the outcomes of size and depth of burn, re-epithelialization, or skin grafting. The evidence is of very low certainty owing to limitations in study design, risk of bias and indirectness., Conclusion: The optimal duration of cooling for thermal burns remains unknown and future prospective research is indicated to better define this treatment recommendation., Competing Interests: Declaration of Competing Interest The authors and members of the Task Force collaborating or acknowledged have no conflicts of interest relevant to this article to disclose., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Elderly burn patients vary in physiologic age and frailty. While previous evidence suggests that frailty on admission is associated with poor outcomes, changes in frailty during hospitalization for a burn injury have not been reported., Methods: We performed a two-year retrospective review of all elderly (≥65years) burn-patients admitted to our burn center. Patients who died during admission were excluded. Data collected include: demographics, injury characteristics, outcomes, and discharge disposition. Canadian Study on Health and Aging Clinical Frailty Scores (CFS) were calculated on admission and at discharge. Change in frailty was calculated for each patient. Mean values are represented as mean±standard deviation, median values are represented as median (IQR)., Results: Seventy-nine patients, mean age of 75±8years, with a mean admission CFS was 4.3±1.2 and discharge CFS was 5.1±1.2 were included in the study. The mean change in CFS was -0.55±0.93. Forty-six patients (59%) had no change or an improvement in frailty during hospitalization while 32 (41%) had worsened CFS at discharge. Patients whose CFS was worse at discharge had larger burns (12.8±10.7% vs. 6.28±5.7%), lower admission CFS (3.88±1.5 vs. 4.93±1.0), and longer ICU stays (15.6±18.9 vs. 7.64± 10.6 days) than patients without change in CFS. On multivariate regression analysis TBSA (OR 1.2 (1.07-1.3)) and admission CFS of 1-4 (OR 7.9 (2.2-28)) were significant predictors of worsened CFS at discharge., Conclusions: In our study population, patients with low admission frailty scores are at greatest risk for worsened frailty at discharge and should be targeted for the development of future frailty prevention programs., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: Following a severe burn injury, significant hematologic changes occur that are reflected in complete blood count (CBC) measurements. Our aim for this study was to examine trend in the components of the CBC in severely burned patients over the first week after injury and compare differences in CBC components between survivors and non-survivors., Methods: A 5-year retrospective review was performed of adult (≥18years) burn patients with a TBSA≥15%. Age, TBSA, gender, mortality, length of hospital stay, ventilator days, and CBC were collected., Results: Over the first week after injury, HBG and HCT decreased. This decrease was due to loss of red blood cells. WBC counts was initially elevated but decreased over the first 4days. PLT also decreased over the first 4days. Non-survivors had lower HBG, HCT, RCC, and PLT over the first week compared to survivors. Non-survivors had higher WBC compared to survivors. RDW was elevated during the first week in non-survivors. MPV was elevated at the end of the first week in non-survivors and MPV on day 7 was independently associated with mortality (O.R. 2.01 (1.1-3.7)). Compared to survivors non-survivors received more transfusions of blood products during the first week after injury., Conclusion: Burn-injury specific trends in CBC measurements can be used as references to determine expected clinical course of burn patients. Non-survivors have early hematologic differences compared to survivors., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Background: Tracheostomy is often performed in the pediatric burn population to establish secure airways. Tracheostomy is safe in this population, but the duration of tracheostomy may be related to age and extent and severity of burn. We hypothesized that burn related factors and not age determine the time to removal of a tracheostomy in pediatric burn patients., Methods: A 5-year retrospective review was performed for pediatric burn patients (age ≤18 years) who underwent tracheostomy. Patients were divided into three groups by age (group 1: 0 to ≤2 years, group 2: >2 to ≤12 years, group 3: >12 to ≤18 years). Data collected included: age, total body surface area burn injured (TBSA), gender, mechanism of injury, diagnosis of inhalation injury, mortality, time from injury to admission, time from admission to placement of tracheostomy, time of injury to placement of tracheostomy, duration of tracheostomy, days of mechanical ventilation, and tracheostomy related complications., Results: 45 patients were reviewed. There were no differences in TBSA, length of ICU stay, length of hospital stay, and mortality between the three groups. Additionally, there were no differences in ventilator days and duration of tracheostomy. Multivariate linear regression analysis indicated that TBSA and not age independently increased the duration of tracheostomy., Conclusion: Tracheostomy duration is dependent on the extent of burn in pediatric burn patients., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

Commercially available interactive video games are commonly used in rehabilitation to aide in physical recovery from a variety of conditions and injuries, including burns. Most video games were not originally designed for rehabilitation purposes and although some games have shown therapeutic potential in burn rehabilitation, the physical demands of more recently released video games, such as Microsoft Xbox Kinect™ (Kinect) and Sony PlayStation 3 Move™ (PS Move), have not been objectively evaluated. Video game technology is constantly evolving and demonstrating different immersive qualities and interactive demands that may or may not have therapeutic potential for patients recovering from burns. This study analyzed the upper extremity motion demands of Kinect and PS Move using three-dimensional motion analysis to determine their applicability in burn rehabilitation. Thirty normal children played each video game while real-time movement of their upper extremities was measured to determine maximal excursion and amount of elevation time. Maximal shoulder flexion, shoulder abduction and elbow flexion range of motion were significantly greater while playing Kinect than the PS Move (p≤0.01). Elevation time of the arms above 120° was also significantly longer with Kinect (p<0.05). The physical demands for shoulder and elbow range of motion while playing the Kinect, and to a lesser extent PS Move, are comparable to functional motion needed for daily tasks such as eating with a utensil and hair combing. Therefore, these more recently released commercially available video games show therapeutic potential in burn rehabilitation. Objectively quantifying the physical demands of video games commonly used in rehabilitation aides clinicians in the integration of them into practice and lays the framework for further research on their efficacy., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

The Transparent Face Orthosis (TFO) is widely used in the treatment of facial burns to minimize hypertrophic scarring and maintain the contours of the face against deforming scars. Compression of the TFO is achieved with forces provided by the harness system (straps and anchors) used to secure the TFO on the face. A variety of harness system designs are used clinically yet none have been described or compared in the literature. The purpose of this study was to compare seven common methods of TFO harnessing including cost, time, and ease of fabrication. Results showed that harness systems vary in cost from $0.22 to 96.45 and take 2-49 min to fabricate. The 4-point harness was the least expensive and the easiest harness to fabricate. The Beanie Cap harness was the most complex system to make, while the Open Mask Stabilizer was the most expensive. The systems resulted in varying distributions of compression when depicted with three-dimensional laser scanned images. This description and comparison of fabrication materials and methods for TFO harnessing can guide clinicians within the burn community worldwide who have varying skills and resources for facial scar management., (Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.)

Optimizing cardiovascular function to ensure adequate tissue oxygen delivery is a key objective in the care of critically ill burn patients. In recent years several less invasive hemodynamic monitoring techniques (arterial waveform analysis techniques) have become available in clinical practice. These alternative techniques provide beat-to-beat cardiac output measurement and permit preload assessment using volumetric parameters. The aim of this article is to review the currently available data regarding to use of less invasive hemodynamic monitoring methods using the pulse wave analysis in burn unit setting., (Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: The aim of this study was to apply the RIFLE [risk (R), injury (I), failure (F), loss (L) and end-stage kidney disease (E)] criteria in burn ICU patients, to identify the risk factors for occurrence of acute kidney injury (AKI), as well as to analyze the progression between stages (classes) of RIFLE classification, and the impact of progression of AKI on morbidity and mortality., Design: Retrospective, descriptive cohort study., Setting: Single-center, 8 bed burn ICU facility., Patients: All consecutive patients aged >18 years with a burn injury of 20% or more of a total body surface area percent (TBSA%) admitted during a 2-year-period were included in the study., Interventions: None., Measurements and Results: Data of 60 patients were studied. AKI occurred in 32 (53.3%) of patients with severe burns with the maximum RIFLE category: Risk in 9 (28.1%), Injury in 6 (18.8%) and Failure 17 (53.1%). Patients with AKI had a mortality rate of 34.4%. None of patients who did not develop AKI during ICU stay died. Thirteen patients progressed to higher RIFLE I class of AKI. Patients who progressed to higher RIFLE class had higher mortality rate (46%) compared to those who remained at the same (Risk or Injury) RIFLE class (7.7%). The progression to higher RIFLE class was associated with the higher extrarenal SOFA and the higher SOFA at maximum RIFLE class, the use of nephrotoxic drugs, the number of operations, the cumulative fluid balance prior the maximum RIFLE and the presence of sepsis. Logistic regression analysis indicated that maximum SOFA score, presence of sepsis and Failure class of AKI (p=0.033) were the independent risk factors for mortality., Conclusion: This study demonstrated (a) the high incidence of AKI in patients with severe burns; (b) the number of predisposing to progression of AKI factors (severity of organ failure, presence of sepsis, use of nephrotoxic drugs, number of previous surgical operations, cumulative fluid balance); (c) the association of Failure class of acute kidney injury with high mortality., (Copyright (c) 2009 Elsevier Ltd and ISBI. All rights reserved.)