Controversial Issues in Intensive Care-Related Burn Injuries

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.

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