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Controversial Issues in Intensive Care-Related Burn Injuries
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Controversial Issues in Intensive Care-Related Burn Injuries

A special issue of European Burn Journal (ISSN 2673-1991).

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 4303

Special Issue Editor

Dr. Athina Lavrentieva

E-Mail Website
Guest Editor
Burn ICU, Papanikolaou Hospital, Hadzipanagiotidi 2, Panorama, 55236 Thessaloniki, Greece
Interests: burn care; hemodynamic monitoring; sepsis; acute kidney Injury
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Because of the inherent severity of their diseases, critically ill burn patients undergo a variety of interventions and medical treatments. A burn-injured patient presents unique challenges regarding resuscitation requirements, metabolic stress, patterns of complications, and therapies using new dressings and skin substitutes. However, the evidence base for the use of different treatment modalities has gaps and limitations that urgently need to be addressed.

Taking into account the multifactorial pathophysiology of burn injuries, several adjunctive therapies have been suggested in an attempt to interrupt, or at least modulate, certain pathways known to contribute to organ failure. The use of hemadsorption therapies seems attractive and appears to hold promise. Harnessing mitochondrial efficiency is also believed to positively impact the body’s redox balance and its immunity. Currently suggested strategies include the use of micronutrients and pharmacological agents. Sustained metabolic stress drives cytokine production and myocardial depression and induces a state of catabolism, contributing to the propagation of organ dysfunction in burn patents. Hence, the concept of attenuation in postburn metabolic stress with the use of cardio-selective beta-1 adrenergic blocker and dexmedetomidine could represent an attractive method of reducing the amount of circulating catecholamines, attenuating sympathetic drive, improving hemodynamic status, and modulating immune system function by limiting cytokine production.

A burn-injured patient presents special challenges in terms of resuscitation requirements. With a lack of unequivocal evidence, there is currently little agreement regarding optimal fluid resuscitation regimens and the role of colloids, such as albumin.

In critically ill burn patients, the microbiological milieu in the gut changes drastically, meaning that the actual number of organisms and their virulence is altered. There is a loss of microbial diversity, along with a wide range of existing gut microbes being replaced by more virulent microbes, which have a predilection for specific areas of the gut. Therefore, strategies to map the gut microbiome and manipulate the micro-organism landscape have become an area of intensive research and interest.

Recent technological advancements, including advancements in biomaterials and tissue engineering, have made burn care more efficient; however, an ideal biomaterial that resembles the structure of the skin has yet to be developed. There have been promising attempts to create bioactive dressings and skin substitutes that actively support the functionality of the wound and accelerate the healing process.

In this Special Issue, we welcome studies that employ innovative methodological approaches to address key principles, gaps, and limitations in research and clinical evidence. This Special Issue will highlight a selected group of papers focused on aspects of care that are unique to burn centers and burn-injured patients and could contribute in important ways to improving outcomes. Topics are not restricted to the examples provided.

Dr. Athina Lavrentieva
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. European Burn Journal is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 971 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • burn injuries
  • metabolic stress
  • treatment modalities
  • optimal fluid resuscitation
  • adjunctive therapies
  • technological advancements

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Published Papers (6 papers)

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Research

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17 pages, 266 KiB  
Article
It Is Written in the Clot: Coagulation Assessment in Severe Burn Injury
by Eirini Nikolaidou, Andriana Lazaridou, Christina Iasonidou, Alexandra Tsaroucha, Sophia Papadopoulou, Eleni Kaldoudi, Apostolos Sovatzidis and Despoina Kakagia
Eur. Burn J. 2025, 6(3), 37; https://doi.org/10.3390/ebj6030037 - 24 Jun 2025
Viewed by 56
Abstract
Background: Coagulopathy in severe burn injury is associated with complications and mortality. Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn [...] Read more.
Background: Coagulopathy in severe burn injury is associated with complications and mortality. Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis. Results: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p < 0.05). These changes were underlined through abnormal measurements of coagulation factors. Conclusions:CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality. Full article
(This article belongs to the Special Issue Controversial Issues in Intensive Care-Related Burn Injuries)
12 pages, 686 KiB  
Article
Characterisation of Fluid Administration in Burn Shock—A Retrospective Cohort Analysis
by Marianne Kruse, Ida Katinka Lenz, David Josuttis, Philip Plettig, Klaus Hahnenkamp, Denis Gümbel, Claas Güthoff, Bernd Hartmann, Martin Aman, Marc Dominik Schmittner and Volker Gebhardt
Eur. Burn J. 2025, 6(2), 35; https://doi.org/10.3390/ebj6020035 - 10 Jun 2025
Viewed by 199
Abstract
Background: Finding the optimal amount of fluid is a major challenge in burn shock. Although there is evidence that a restrictive fluid regime is beneficial, current practice shows fluid resuscitation still well above recommendations. The extent of trauma, pre-hospital care and the patient’s [...] Read more.
Background: Finding the optimal amount of fluid is a major challenge in burn shock. Although there is evidence that a restrictive fluid regime is beneficial, current practice shows fluid resuscitation still well above recommendations. The extent of trauma, pre-hospital care and the patient’s pre-existing conditions influence requirements. Methods: We analysed outcomes and influencing factors of fluid regimes in a retrospective cohort study including 90 severely burnt patients resuscitated with the same protocol. Results: The mean amount of fluids in the first 24 h was 6.5 mL/kg bodyweight (BW)/% total burn surface area (TBSA). A total of 14% received restrictive (<4), 34% received liberal (4–6) and 51% received excessive (>6) mL/kgBW/%TBSA fluids. There was no difference regarding mortality, age, complications, organ failure, inhalation injury or full-thickness burns in the groups. Patients with excessive fluid therapy had a significantly lower ABSI score (9 vs. 11, p = 0.05) and TBSA (35 vs. 51%, p < 0.001), while patients with a restrictive fluid therapy needed fewer incidences of surgery to cover burn wounds (3.5 vs. 9.0 vs. 7.0, p = 0.008). History of liver disease or alcohol abuse tended to indicate excessive fluid administration. Patients with pre-existing heart failure received restrictive fluid therapy (23 vs. 3 vs. 4%, p = 0.03). Conclusions: Individualised, timely therapy monitoring is as essential as identifying patients with a higher or lower fluid requirement. Excessive fluid resuscitation had fewer deleterious consequences in complications than expected but seems to influence wound healing. Awareness of circumstances that prompt deviations from recommended fluid rates remains elementary. Full article
(This article belongs to the Special Issue Controversial Issues in Intensive Care-Related Burn Injuries)
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18 pages, 1716 KiB  
Article
Pediatric Burn Treatment with Non-Thermal Atmospheric Plasma and Epifast®: Clinical Results
by Pablo Rodríguez-Ferreyra, Régulo López-Callejas, Teresa Narváez-Robles, Benjamín Gonzalo Rodríguez-Méndez, Omar Israel Gayosso-Cerón, Antonio Mercado-Cabrera, Irene Lule-Reyna, Othoniel Mondragón-Dagio, Raúl Valencia-Alvarado and Jesús Duarte-Mote
Eur. Burn J. 2025, 6(2), 20; https://doi.org/10.3390/ebj6020020 - 14 Apr 2025
Viewed by 659
Abstract
The effective treatment of severe burns in pediatric patients is essential for minimizing complications and promoting optimal recovery. This study investigates the use of non-thermal atmospheric pressure plasma (NTAPP) as an adjuvant therapy in combination with Epifast® for the experimental group, compared [...] Read more.
The effective treatment of severe burns in pediatric patients is essential for minimizing complications and promoting optimal recovery. This study investigates the use of non-thermal atmospheric pressure plasma (NTAPP) as an adjuvant therapy in combination with Epifast® for the experimental group, compared to standard care involving early excisions and Epifast® for the control group. A randomized controlled trial was conducted with 40 pediatric patients suffering from superficial partial-thickness and deep dermal burns. The experimental group that received NTAPP daily demonstrated a significant reduction in the need for skin grafts, requiring only 10% compared to 40% in the control group (p = 0.02). Although there were no statistically significant differences in the length of hospital stay, the experimental group showed a trend toward shorter stays (9.85 days vs. 11.65 days; p = 0.38) and lower analgesic consumption (13.01 doses vs. 21.15 doses; p = 0.09). Additionally, the infection rate in the NTAPP-treated group was significantly lower at 25%, compared to 37.95% in the control group (p < 0.05). These findings suggest that NTAPP enhances wound healing while reducing surgical morbidity and the risk of infections. In conclusion, this study highlights the transformative potential of NTAPP as an innovative strategy in pediatric burn management. It combines clinical efficacy with a less invasive approach, representing a significant advance in regenerative medicine and opening new avenues for research into advanced therapies. Full article
(This article belongs to the Special Issue Controversial Issues in Intensive Care-Related Burn Injuries)
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13 pages, 2091 KiB  
Article
Emergency Treatment of Burns in Adults—Characteristics of Adult Patients and Acute/Pre-Hospital Burn Management
by Bogdan Oprita, Georgeta Burlacu, Vlad Mircea Ispas, Ioana Adriana Serban and Ruxandra Oprita
Eur. Burn J. 2025, 6(2), 19; https://doi.org/10.3390/ebj6020019 - 10 Apr 2025
Viewed by 395
Abstract
Background: Burns represent one of the most severe injuries encountered in the pre-hospital and ED environment, with essential features and an often negatively powerful impact on patients’ quality of life. Preventive measures can significantly reduce the number of cases presenting to medical facilities; [...] Read more.
Background: Burns represent one of the most severe injuries encountered in the pre-hospital and ED environment, with essential features and an often negatively powerful impact on patients’ quality of life. Preventive measures can significantly reduce the number of cases presenting to medical facilities; knowledge and the correct application of first aid measures in the pre-hospital stage have a significant role in reducing the risk of complications and in obtaining optimal outcomes. Methods: This retrospective one-year single-center study analyzed 399 adult burn patients treated at the Clinical Emergency Hospital of Bucharest (CEHB) in 2023. Information concerning the main characteristics of the patients (age, sex, and residence), etiology and severity of burns, and pre-hospital management of patients was analyzed. Results: Most patients (63.41%) resided in urban areas, with a higher prevalence of males (55.89%). Thermal burns accounted for 77.69% of cases, primarily caused by water, food, oil, or flames. Burns covered ≤10% TBSA in 77.19% of cases, while 6.52% extended beyond 50% TBSA. First aid was provided to 52.63% of patients at the accident site, often by non-specialized individuals. The mean time to presentation was 34.90 h, with significant correlations between time, age, burned body surface area, and burn depth. Conclusions: There is a real need for improvements in first-aid training and health initiatives to enhance pre-hospital burn care. Better documentation of the care provided to patients before being admitted to specialized centers, as well as further studies in this field, are absolutely necessary for improving prevention programs and burn management in the acute stage. Full article
(This article belongs to the Special Issue Controversial Issues in Intensive Care-Related Burn Injuries)
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9 pages, 785 KiB  
Article
Mind the Gap! Core-Peripheral Temperature Gradient and Its Relationship to Mortality in Major Burns
by Niamh Keohane, Jennifer Driver, Randeep Mullhi, Elizabeth Chipp, Barbara Torlinska and Tomasz Torlinski
Eur. Burn J. 2025, 6(1), 11; https://doi.org/10.3390/ebj6010011 - 2 Mar 2025
Viewed by 572
Abstract
The association between hypothermia and poor outcomes in severe burn injury is well established. However, the significance of the core-peripheral temperature gradient has not previously been investigated. Institutional guidance at our burns centre advocates avoiding hypothermia and targeting a body temperature between 37.5 [...] Read more.
The association between hypothermia and poor outcomes in severe burn injury is well established. However, the significance of the core-peripheral temperature gradient has not previously been investigated. Institutional guidance at our burns centre advocates avoiding hypothermia and targeting a body temperature between 37.5 and 39.5 °C. The core-peripheral temperature gap should be ≤2 °C, based on expert opinion. Data from 61 patients admitted to the Intensive Care Unit (ICU) with severe burns between 2016 and 2022 were analysed. A higher core temperature at 48 h, avoidance of hypothermia and a core-peripheral temperature gap > 2 °C were associated with reduced odds of mortality. The mean core body temperature and core-peripheral temperature gap increased over the first 48 h (r = 0.5, p < 0.001). All non-survivors had a core-peripheral gap < 2 °C at 48 h. Survivors had a higher mean 48 h gap (1.6 [95%CI:1.3–1.9]) than non-survivors (0.8 [95%CI:0.2–1.4; p = 0.04]). Our findings support previous studies suggesting that avoiding hypothermia and achieving a higher target temperature are associated with reduced mortality. However, it challenges the previous expert consensus that a lower core-peripheral gap indicates better outcomes. Further research with a larger cohort of patients is required to identify whether a higher core-peripheral temperature gap predicts outcomes in critically ill patients with severe burns. Full article
(This article belongs to the Special Issue Controversial Issues in Intensive Care-Related Burn Injuries)
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Review

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14 pages, 1490 KiB  
Review
Early Detection, Diagnosis, Prevention, and Treatment of Infection to Avoid Sepsis and Septic Shock in Severely Burned Patients: A Narrative Review
by Patrick M. Honoré, Sydney Blackman, Emily Perriens, Jean-Charles de Schoutheete and Serge Jennes
Eur. Burn J. 2025, 6(1), 6; https://doi.org/10.3390/ebj6010006 - 6 Feb 2025
Viewed by 1525
Abstract
The early detection, diagnosis, anticipation, and therapy of infections to prevent sepsis and septic shock remain significant challenges in cases of grave burns. This narrative review explores various tools for early infection detection, including emerging biomarkers, the American Burn Association’s clinical criteria, and [...] Read more.
The early detection, diagnosis, anticipation, and therapy of infections to prevent sepsis and septic shock remain significant challenges in cases of grave burns. This narrative review explores various tools for early infection detection, including emerging biomarkers, the American Burn Association’s clinical criteria, and traditional blood parameters. A comparative study of the American Burn Association, Mann-Salinas, and Sepsis-3 criteria highlights the superior early detection capabilities of the Sepsis-3 criteria. However, the authors recommend that sepsis should be prospectively evaluated, identified, and classified by the intensive care group, rather than by relying solely on retrospective items, though the latter may still be necessary in certain cases. Advances in biomarker identification, including polymerase chain reaction (PCR) and gene expression (mRNA) profiling, offer diagnostic advantages over current methods, enabling early detection within 4 to 6 h of intensive care unit admission. Mass spectrometry also shows promise for the rapid determination of bacteria, yeast, and fungi based on bacteria protein profiles. Source control remains crucial, and the use of antibacterial topical agents has significantly improved the survival rates of severely burned patients. However, antibiotic selection must be made judiciously to avoid resistance. Despite these advancements, significant progress is still needed to improve the rapid identification, actual presence, prevention, and therapy of infections to reduce the incidence of sepsis and septic shock in this patient subgroup. Full article
(This article belongs to the Special Issue Controversial Issues in Intensive Care-Related Burn Injuries)
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