Complications In Burn Patients Research Articles

The Effect of Diabetes Mellitus Severity on Foot & Ankle Burn Recovery

Background: Diabetic patients often present with complex limb pathology, resulting in impaired sensation in the distal extremities making tactile injuries such as burns difficult to notice. We posit that poorly controlled diabetes mellitus, evidenced by increasing elevations in hemoglobin A1c, is associated with delayed wound healing and increased complications in burn patients. Methods: The TriNetX Network, a database of 89 million patients across the U.S., was queried for diabetic patients with foot and ankle burns. Patients were divided into four groups based on A1c: properly controlled (<7%), moderately controlled (7–9%), poorly controlled (>9%), and propensity-matched non-diabetic controls. Evaluated outcomes included split-thickness skin grafting, infections, amputations, acute kidney failure (AKF), and mortality within one month of the burn. Results: When comparing the poorly controlled A1c cohort with the properly controlled and moderately controlled A1c cohorts, we found a significant increase in amputations (p = 0.042) and cutaneous infections (p = 0.0438), respectively. When evaluating non-diabetics to diabetic patients, significantly increased rates of amputations (p < 0.0001), cutaneous infections (p = 0.0485), systemic infections (p = 0.0066), and AKF (p = 0.0005) were noted in the latter. Conclusions: Poorly controlled diabetes shows a significant correlation with increased complications following foot and ankle burns, including amputations, infections, and AKF.

Longitudinal analysis of ARDS variability and biomarker predictive power in burn patients

Acute Respiratory Distress Syndrome (ARDS) is a severe complication in burn patients, characterized by rapid lung inflammation and hypoxemia. Managing ARDS is challenging due to its high mortality rates and the complex interplay of various pathophysiological factors. This study aims to investigate the heterogeneity of ARDS in burn patients admitted to the Intensive Care Unit (ICU) and evaluate the predictive efficacy of biomarkers in comparison to the PaO2/FiO2 (PF) ratio. A retrospective cohort study was conducted at the Burn Intensive Care Unit of Hangang Sacred Heart Hospital in Seoul, Korea, from July 2010 to December 2022, involving 2,318 patients. Longitudinal k-means clustering was employed to identify patient subgroups based on PF ratio trajectories. Biomarkers, including albumin, white blood cell (WBC) count, and lactate, were assessed for their predictive accuracy using multivariable logistic regression, area under the curve (AUC) analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Four distinct patient clusters were identified. Cluster A exhibited the highest mortality rate at 54.9%, while Cluster D showed the lowest at 7.9%. Albumin demonstrated significantly higher predictive accuracy in Cluster A (AUC: 0.905, NRI: 0.421) and Cluster C (AUC: 0.915, NRI: 0.845), outperforming the PF ratio in both groups. However, in Clusters B and D, biomarkers did not significantly improve upon the predictive power of the PF ratio. Across all clusters, the integration of biomarkers with the PF ratio led to modest improvements but did not consistently outperform the PF ratio as a standalone predictor. This study reveals substantial heterogeneity in ARDS progression among burn patients, with varying mortality rates and biomarker efficacy across clusters. While biomarkers such as albumin showed potential in specific subgroups, their overall contribution to predictive accuracy was limited. Further multicenter, prospective studies are required to validate these findings and develop more refined predictive models. Personalized treatment strategies, based on biomarker profiles and traditional clinical metrics, could enhance ARDS management in burn patients.

Detection of OXA-23, OXA-48, OmpA and bla-TEM genes in carbapenem-resistance Acinetobacter baumannii and biofilm formation in burn patients at Al-Anbar Government

Background. Antibiotic-resistant bacteria represent a highly global health issue by causing high rates of morbidity and mortality in burn units, whereas biofilms significantly contribute to complications in burn patients. Objectives. The study investigates the prevalence of (OXA-23, OXA-48, OmpA and bla-TEM) and biofilm formation of Acinetobacter baumannii in the Burn Unit of the Al-Anbar government. Methods. A total of 120 clinical swab samples from burn patient were collected from December 2023 to April 2024 from the burn units of Ramadi Teaching Hospital and Falluja Teaching Hospital for the study. The colonies were identified using conventional and Vitek methods. Colorimetric technique (MTP) and multiplex PCR were used to detect biofilms and resistance genes. Results. Among 120 samples, 40 (33.3%) were Acinetobacter baumannii, 34 (80%) were MDR- resistant, and 6 (15%) were XDR. 90% of the isolates were resistant to Cefotaxime, and Colistin was more sensitive in all forty isolates. All 40 isolates formed significant biofilms. The percentage of positive results for OXA-23, OmpA and bla-TEM genes were 80%, 65%, and 55% of respectively. Carbapenem testing is essential to identify carbapenem-producing strains from non-producing strains due to the high prevalence of multidrug-resistant A. baumannii with the OXA-23 and OmpA genes. Conclusion. These findings highlight the urgent need for effective infection control measures and the development of new therapeutic strategies to manage these infections in burn patients.

Identification of fungal agents isolated from burn lesions using mycological and molecular methods in patients admitted to Velayat burn hospital in Rasht city during 2022-2023.

Fungal burn wound infections (FBWIs) are one of the most disastrous complications in burn patients. The present study investigated the incidence and the species distribution of fungal agents isolated from burn lesions and reviewed the feautures, underlying conditions, and outcomes of patients. The wounds were swabbed and cultured on Sabouraud Dextrose Agar with chloramphenicol medium. Fungal identification was performed using internal transcribed spacer (ITS) and beta-tubulin sequencing. A total of 380 swab specimens were obtained. Of these, 101 patients (26.75 %) were positive in culture. Among the 101 positive cases, most isolates were from males (n= 68, 67.33%) and most of them were over 30 years old. Flame (n=38, 37.63%) was the predominant cause of burns, and previous history of ICU admission (n=35, 34.66%), presence of central venous catheter (n=25, 24.75%), and diabetes mellitus (n=17, 16.83%) were the main underlying conditions. Candida parapsilosis complex (n=36, 35.64%), and Pichia kudriavzevii (C. krusei) (n=8, 7.92%) represent the most commonly isolated species Also, 2 out of 101 patients (2%) died. In the present study, non-albicans Candida species were much higher frequent than C. albicans with most cases associated with Candida parapsilosis complex.

Managing Healing Complications in Burn Patients

Managing Healing Complications in Burn Patients

Investigating the impact of patient-centered peer counseling on anxiety and pain among burn patients: A randomized controlled trial

ObjectivePain and anxiety are common complications in burn patients, significantly impacting treatment effectiveness and overall patient well-being. Peer counseling, a form of patient education provided by individuals with shared experiences, may hold potential to alleviate this pain and anxiety. This study seeks to investigate the effectiveness of patient-centered education through peer counseling on background pain and state anxiety levels in these patients. MethodsA two-arm, parallel, randomized, controlled trial design was employed. A total of 86 participants were randomly allocated to one of two groups: control and intervention groups. State anxiety and background pain levels were assessed using the Spielberger State Anxiety Inventory (STAI) and Visual Analogue Scale (VAS), respectively, before and after intervention. Statistical analyses, including Chi-square test, Fisher's exact test, independent t-test, and paired t-test, were employed to analyze the data. ResultsThe intervention significantly reduced pain and anxiety in the intervention group compared to baseline (p < .001). There was no significant difference between the control and intervention groups in baseline levels, but there was a significant difference after the intervention (p < .001). ConclusionThis study demonstrates the efficacy of patient-centered education through peer counseling in reducing background pain and state anxiety levels in burn patients. Compared to standard education, peer counseling led to a more pronounced reduction in both pain and anxiety, suggesting its potential as a valuable nonpharmaceutical intervention to improve patient well-being during burn recovery. Practice implicationsBased on our findings, we recommend that healthcare providers consider implementing peer-based education programs in burn care settings.

Severity of Inhalation Injury and Risk of Nosocomial Pneumonia: A Retrospective Cohort Study

BackgroundThe impact of inhalation injury on risk of nosocomial pneumonia, an important complication in burn patients, is not well established. Research QuestionIs more severe inhalation injury associated with increased risk of nosocomial pneumonia? Study Design and MethodsWe performed a retrospective cohort study of patients with suspected inhalation injury admitted to a regional burn center from 2011 to 2022 who underwent diagnostic bronchoscopy within 48 hours of admission. We estimated the association of high-grade inhalation injury (abbreviated injury score [AIS] 3-4) versus low-grade inhalation injury (AIS 1-2) with nosocomial pneumonia (NP) adjusted for age, burn size, and comorbid obstructive lung disease. Death and hospital discharge were considered competing risks. ResultsOf the 245 patients analyzed, 51 (21%) had high-grade injury, 180 (73%) had low-grade injury, and 14 (6%) had no inhalation injury. Among the 236 patients hospitalized for >48 hours, NP occurred in 24/50 (48%) patients in the high-grade group, 54/172 (31%) in the low-grade group, and 2/14 (14%) in the no inhalation injury group. High-grade (vs low-grade) inhalation injury was associated with higher hazard of NP in both the proportional cause-specific hazard model (CSHR 2.04; 95% CI, 1.26-3.30; p=0.004) and Fine-Gray subdistribution hazards model (SHR for NP, 2.24; 95% CI, 1.38-3.64; p=0.001). InterpretationAmong patients with inhalation injury, more severe injury was associated with higher hazard of NP in competing risk analysis. Additional research is needed to investigate mechanisms that may explain the relationship between inhalation injury and NP and to identify more effective prevention strategies.

Deciphering AKI in Burn Patients: Correlations between Clinical Clusters and Biomarkers.

Acute kidney injury (AKI) is a significant complication in burn patients, impacting outcomes substantially. This study explores the heterogeneity of AKI in burn patients by analyzing creatinine time-series data to identify distinct AKI clusters and evaluating routine biomarkers' predictive values. A retrospective cohort analysis was performed on 2608 adult burn patients admitted to Hangang Sacred Heart Hospital's Burn Intensive Care Unit (BICU) from July 2010 to December 2022. Patients were divided into four clusters based on creatinine trajectories, ranging from high-risk, severe cases to lower-risk, short-term care cases. Cluster A, characterized by high-risk, severe cases, showed the highest mortality and severity, with significant predictors being PT and TB. Cluster B, representing intermediate recovery cases, highlighted PT and albumin as useful predictors. Cluster C, a low-risk, high-resilience group, demonstrated predictive values for cystatin C and eGFR cys. Cluster D, comprising lower-risk, short-term care patients, indicated the importance of PT and lactate. Key biomarkers, including albumin, prothrombin time (PT), cystatin C, eGFR cys, and total bilirubin (TB), were identified as significant predictors of AKI development, varying across clusters. Diagnostic accuracy was assessed using area under the curve (AUC) metrics, reclassification metrics (NRI and IDI), and decision curve analysis. Cystatin C and eGFR cys consistently provided significant predictive value over creatinine, with AUC values significantly higher (p < 0.05) in each cluster. This study highlights the need for a tailored, biomarker-driven approach to AKI management in burn patients, advocating for the integration of diverse biomarkers in clinical practice to facilitate personalized treatment strategies. Future research should validate these biomarkers prospectively to confirm their clinical utility.

Bacteriological characteristics of infectious complications in burn patients

Bacteriological characteristics of infectious complications in burn patients

Reports on vascular catheter-associated thromboembolic events in a burn unit - a gap in the literature?

Indwelling intravascular catheters are important tools in the care of critically ill patients; however, they have an inherent risk of infection or thromboembolic events. Reports on catheter associated thromboembolic events in burn units are rare, despite being well recognized that burn patients bear an increased baseline risk for thromboembolic events. We describe two catheter-associated thromboembolic complications in burn patients in a burn unit and the morbidity associated with these events. Patients with endovascular catheters in burn units may be at increased risk for severe thromboembolic events associated with intravascular catheters, but specific guidelines for prevention and management of these patients are still missing.

57 HIV Infection Increases Risk of Sepsis and Other Complications in Burn Patients

57 HIV Infection Increases Risk of Sepsis and Other Complications in Burn Patients

114 Burn Specific VTE Prophylaxis: Higher Enoxaparin Dose and Anti-Xa Adjustments Is Safe and Potentially Beneficial

Abstract Introduction Burn and trauma patients are at high risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolus (PE). VTE prophylaxis guidelines for trauma patients recommends a higher standard dose of enoxaparin and anti-Xa level adjustments in select patients; however, no guidelines specific to burn patients exist. We hypothesize that higher standard doses of enoxaparin and anti-Xa level adjustments will be safe and effective at reducing VTE complications in burn patients. Methods This retrospective review included patients admitted to a regional burn center six months prior to and after the initiation of a VTE prophylaxis quality improvement protocol. The protocol doubled the standard dose of enoxaparin, 40 mg daily to 40 mg twice a day, for all burn patients who were &amp;gt; 50 kg and had creatinine clearance &amp;gt; 60mg/dl. Peak anti-Xa level monitoring was indicated if a high-risk factor (TBSA ≥20%, inhalation injury, burn shock, BMI ≥40) was present. Patients on therapeutic anticoagulation or anti-platelet therapy, had a history of chronic kidney disease, decompensated cirrhosis, coagulation disorder, heparin induced thrombocytopenia (HIT), or were admitted for polytrauma were excluded. Efficacy was evaluated by rates of VTE within 31 days of discharge. Safety was evaluated by bleeding complications, including estimated blood loss (EBL), number of transfusions and gastrointestinal (GI) bleeding events. Differences between groups were compared using a two-sample t-test or Wilcoxon rank-sum test. A p-value of &amp;lt; 0.05 signified statistical significance. Results The pre-protocol group included 217 patients and the post-protocol group included 207 patients. There were no significant differences in age (45 vs 44 years), BMI (27 vs 26.4 kg/m2), TBSA (5.9 vs 5.3%), IHI (4.6 vs 7%), number of procedures (3 vs 3), mortality (4.1 vs 3%), or ICU length of stay (1.9 vs 1.6 days) between groups. No significant difference in EBL (50 vs 25 cc), number of transfusions (3.3 vs 2.4 units), or GI bleeding events (1 vs 1) was noted between groups, and no patient developed thrombocytopenia or HIT. There were 5 patients (2.3%) with a VTE within 31 days of discharge in the pre-protocol group compared to 1 patient (0.4%) in the post-protocol group (p=0.19). There was not enough power to determine statistically significant VTE prevention. Conclusions A lack of VTE prophylaxis recommendations for burn patients leads to variability in protocols among burn centers. These protocols are infrequently studied. This protocol, which doubled the standard dose of enoxaparin and adjusted based on anti-Xa levels for high-risk patients, was safe. Efficacy and applicability to other centers needs further elucidation. Applicability of Research to Practice Enoxaparin 40mg twice a day with anti-Xa level adjustments is safe and a promising strategy to reduce the rates of VTE in the burn population without increasing bleeding complications.

Effect of glycemic variability on infectious outcomes in critically Ill burn patients

After acute burn injury, patients experience a hypermetabolic state often complicated by a stress-induced hyperglycemia. Recent research points towards glycemic variability as a contributing factor in adverse outcomes in critically ill patients. In burn patients, greater glycemic variability has been associated with increased rates of mortality and sepsis. However, no studies to date have examined the impact of glycemic variability on rates of infection in this population or determined which measure may be most useful. Infection, and subsequent sepsis, remains the leading contributor to morbidity and mortality after burn injury. The primary objective of this study is to evaluate the relationship between different measures of glycemic variability and infectious complications in burn patients. This retrospective study included patients admitted to a single American Burn Association-verified burn center between January 1, 2020 and December 31, 2020 with burn or inhalation injury. The primary outcome was a composite of autograft loss, mortality, and proven infection. Secondary outcomes included hospital length of stay and a further analysis of the proven infection component of the composite primary outcome. In addition to mean glucose, several different measures of glycemic variability were used for comparison, including standard deviation, coefficient of variation, mean amplitude of glycemic excursions, and J-index. Outcomes were analyzed using multiple logistic regression analysis while controlling for revised Baux score. A quantile analysis was performed to do determine the optimal mean threshold. Three hundred and ninety-two patients were admitted and screened for inclusion during the study period. Most patients were excluded due to a LOS less than 72 h. 112 patients were included in the study. Of the 112 patients, 22.3% experienced an infectious complication (25 patients with 28 complications). Mean glucose (OR 1.024; 95% CI 1.004–1.045) and J-index (OR 1.044; 95% CI 1.003–1.087) were associated with occurrence of infectious complications. Regarding target mean glucose threshold, a daily mean glucose above 150 mg/dL showed the strongest association with infectious complications (OR 3.634; 95% CI 1.008–13.101). Mean glucose, standard of deviation, and J-index were all independently associated with proven infection.

Phage therapy for burn wound infections in the era of antibiotic resistance

Infection of burn wounds caused by antibiotic-resistant pathogens is the leading cause of systemic infectious complications in burned patients and a key link in the pathogenesis of burn disease, causing its course and outcome. The use of phage therapy to overcome antibiotic resistance of infection agents is a promising direction, the development of which can improve the results of treatment of burned. The article discusses: 1) features of the infectious process in burned; 2) the effect of antibacterial chemotherapy of burn wound infection on the microbiome and the processes of reparative regeneration; 3) principles of phage therapy; 4) ways of delivering bacteriophages; 5) development of resistance to bacteriophages 6) personalization of phage therapy.

A Bibliometric Analysis of the Trends and Evolution on Inhalation Injury Research.

Inhalation injury is a common complication in burn patients and is also a factor that can affect the multiple prognoses of burn patients. Attention to inhalation injury began early globally, but few articles have systematically analyzed its development. We employed bibliometric methods to analyze articles on inhalation injury published in 3 medical databases. A total of 3056 relevant articles on inhalation injury were included in our analysis and divided into 3 distinct periods based on Price's law. Notably, a slowdown in publication growth was observed in period III. The majority of these articles were authored by a small group of individuals, with a significant proportion of them being American scholars. In fact, nearly half of the articles were published by American researchers. Applying Bradford's Law, we identified 4 major output sources in the field, namely Burns, Journal of Burn Care & Research, Journal of Trauma, and Critical Care Medicine. Recent research has focused on the clinical risks and outcomes associated with inhalation injury, while basic research in this area has been relatively neglected over the last decade. In conclusion, the growth of publications on inhalation injuries has largely followed standard scientific growth patterns, with a small number of countries and established research groups contributing the majority of articles. However, the recent slowdown in scientific output is a cause for concern, and the lack of emphasis on basic research and clinical trials in this field raises questions about the foundation for widespread clinical management of inhalation injuries.

707 Comparing VTE Prophylaxis Strategies in Thermal Injuries: Don't Get Burned by Heparin!

Abstract Introduction Burn patients are at high risk of venous thromboembolism (VTE) as well as bleeding complications, thus choosing the best option for thromboprophylaxis can be challenging. Previous studies have analyzed the preferred antithrombotic agent in trauma patients, but this has not been established in burns. We hypothesize that low molecular weight heparin (LMWH) is associated with better outcomes than unfractionated heparin. Methods The Trauma Quality Improvement Project (TQIP) dataset was used to identify all patients with second- or third-degree burns that were administered VTE prophylaxis. Cases with missing data, &amp;lt; 24-hour hospital length of stay, other serious traumatic injuries (any AIS &amp;gt;3), interhospital transfer, history of kidney disease, or pre-hospital history of anticoagulant use were excluded. Bleeding complications were defined as hemorrhage control surgery, embolization procedures, or blood transfusion occurring after the initiation of thromboprophylaxis, consistent with other studies analyzing bleeding complications in TQIP. Rates of VTE and bleeding complications were compared between those who received heparin versus LMWH. Propensity score matching was performed to control for age, total body surface area percent (TBSA%) burned, and ICU admission (Table 1). Results The analysis included 9,857 patients (69% male). Median age was 50 (34-62) years. LWMH was associated with fewer complications including pulmonary embolism, any VTE, and bleeding (Table 2). Initiation of thromboprophylaxis within 24 hours of arrival was associated with a lower risk of VTE (1.0% vs 2.1%, p&amp;lt; 0.001) without showing a significant difference in bleeding complications (6.4% vs 7.2%, p=0.206). Conclusions This propensity score matched analysis of nearly ten thousand burn patients has demonstrated that low molecular weight heparin is associated with reduced risk of VTE and bleeding compared to heparin. Initiation of thromboprophylaxis within 24 hours is linked to lower rates of VTE. In burn patients without contraindications, thromboprophylaxis with LMWH should be started within 24 hours. Applicability of Research to Practice Venous thromboembolism is an important complication in burn patients, which may negatively impact patient outcomes. These patients regularly receive DVT prophylaxis and it is important for their care team to be able to select the proper agents.

62 Effect of Glycemic Variability on Infectious Outcomes in Patients with Severe Burn Injuries

Abstract Introduction Stress-induced hyperglycemia is a common manifestation of severe burn injury, due to increased catecholamines, glucagon, corticosteroids, and cytokines. The primary objective of this study was to evaluate the relationship between different measures of glycemic variability and infectious outcomes in burn patients. Methods This retrospective electronic chart review included patients admitted to a single American Burn Association-verified burn center for the year of 2020. Infectious complication was defined as occurrence of proven infection, autograft loss, or death. Glycemic variability indices tested include standard deviation, mean amplitude of glycemic excursions, J-index, and coefficient of variability. Demographics were compared utilizing Fisher’s exact or Mann-Whitney U test, depending on dichotomy. Logistic regression analysis was utilized to control for revised Baux score. Likelihood ratio test statistic was utilized to compare strength of association. Results Three-hundred and ninety-two patients were admitted during 2020 and screened for inclusion. After applying exclusion criteria, 112 patients remained in the study group. More than half were excluded for length of stay less than 3 days. Twenty-five (22%) had at least one infectious complication (21 infections, 3 with graft loss, and 4 deaths). Revised Baux, age, percent total body surface area burned, history of diabetes, and admission blood glucose were all higher in the group with an infectious complication. Out of the indices tested, only mean glucose (Odds ratio, 95% confidence interval: 1.024, 1.004-1.045) and J-index (1.044, 1.002-1.087) were significantly associated with higher risk of an infectious complication. Quantile analysis of mean glucose thresholds indicated &amp;gt; 150 mg/dL to have the strongest association with infectious complications in burn patients. Conclusions Although J-index was significantly associated with infectious complications, mean glucose was also and has a simpler derivation. Applicability of Research to Practice A liberal glucose control strategy should continue to be avoided in patients with burn injuries due to higher risk of infectious complication.

The modified 5-item frailty index as a predictor of complications in burn patients

The modified 5-item frailty index (mFI-5), as a measure of frailty and biological age, has been shown to be a reliable predictor of complications and mortality in a variety of surgical specialties. However, its role in burn care remains to be fully elucidated. We, therefore, correlated frailty with in-hospital mortality and complications after burn injury. The medical charts of all burn patients admitted between 2007 and 2020 who had ≥ 10 % of their total body surface area affected were retrospectively reviewed. Data on clinical, demographic, and outcome parameters were collected and evaluated, and mFI-5 was calculated on the basis of the data obtained. Univariate and multivariate regression analyses were used to investigate the association between mFI-5 and medical complications and in-hospital mortality. A total of 617 burn patients were included in this study. Increasing mFI-5 scores were significantly associated with increased in-hospital mortality (p < 0.0001), myocardial infarction (p=0.03), sepsis (p=0.005), urinary tract infections (p=0.006), and perioperative blood transfusions (p=0.0004). They were also associated with an increase in the length of hospital stay and the number of surgical procedures, albeit without statistical significance. An mFI-5 score of ≥ 2 was a significant predictor of sepsis (odds ratio [OR]=2.08; 95% confidence interval [CI]: 1.03 to 3.95; p=0.04), urinary tract infection (OR=2.82; 95% CI: 1.47 to 5.19; p=0.002), and perioperative blood transfusions (OR=2.61; 95% CI: 1.61 to 4.25; p=0.0001). Multivariate logistic regression analysis revealed that an mFI-5 score of ≥ 2 was not an independent risk factor for in-hospital mortality (OR=1.44; 95% CI: 0.61 to 3.37; p=0.40). mFI-5 is a significant risk factor for only a few select complications in the burn population. It is not a reliable predictor of in-hospital mortality. Therefore, its utility as a risk stratification tool in the burn unit may be limited.

Complications in Burn Patients Following Fluid Over-Resuscitation

Background/Objective: Over-resuscitation of burn patients leads to dangerous edema-related sequelae. The Parkland formula is commonly used to predict fluid requirements in the 24 hours following burn injury, yet studies report widely varying resuscitation rates. This study aims to assess fluid resuscitation practices at Lutheran Hospital and evaluate correlations between resuscitation rates and fluid-overload complications.Methods: A retrospective chart review assessed fluid resuscitation of 36 adult patients withburns affecting at least 15% total surface body area (TBSA) between May 2020-May 2022 atLutheran Hospital. Intravenous fluid rates and urine output (UO) were recorded for the first 24 hours of each patient’s hospital stay. Complications and mortality were recorded for the entirety of a patient’s hospital stay. Patients who received volumes exceeding those recommended by the Parkland formula were placed in the high-volume group whereas patients who received a lesser volume were placed in the low-volume group. Statistical analyses were performed using Microsoft Excel (α = 0.05).Results: The study included 36 patients with an average fluid resuscitation of 4.13 ±2.14mL/kg/%TBSA in the first 24 hours following hospital admission. Average UO in the high-volume group (n=14) was 1.33 ±0.76 mL/kg/hr compared to 0.75 ±0.47 mL/kg/hr in the low-volume group (n=22). Fluid complications were more common in the high-volume group (41.7%)compared to the low-volume group (19.0%), but this difference was not statistically significant (p=0.230). No difference in mortality was observed (p=1.000).Conclusion: The high-volume group had an average UO exceeding the recommended range(0.5-1.0 mL/kg/hr) and experienced greater rates of fluid-overload complications (pulmonaryedema, compartment syndromes, etc.). Due to the small sample size and limited power of this study, the difference in fluid-related complications was not statistically significant.Clinical Impact and Implications: Physicians should limit fluid volumes exceeding theParkland formula when resuscitating burn patients to avoid fluid overload sequelae.

The Protective Role of Strong Antioxidant Astaxanthin on Burn Wound and Burn-Induced Early Acute Kidney Injury through Abilities to Relieve Oxidative Stress and Inhibit Apoptosis by Modulating Mitochondrial-Apoptotic Pathways

Summary: Burns are skin damage caused by heat trauma or cold trauma (frost bite). Causes include fire, hot water, electricity, chemicals, radiation, and cold (frostbite). This damage may involve subcutaneous tissue. Burn injuries are associated with high incidence and prevalence, high risk of morbidity and mortality, resource-intensive, and costly. One of the most common complications in burn patients is acute kidney injury (AKI). The mechanism of early AKI after burn injury is multifactorial, and previous studies have mainly focused on oxidative stress injury, tubular apoptosis, and systemic or local inflammation. Previous results (from our group and others) suggested that ROS-induced oxidative stress damage and apoptosis play an important role in the development of early AKI due to burn injury, and that 24 h after burn injury are useful for observing changes in burn injury. It shows that it provides an important timeframe. Kidney function and levels of oxidative stress and apoptosis. Astaxanthin (ATX) is a naturally occurring carotenoid that is readily obtained from marine organisms and stronger antioxidant effects than other carotenoids. Given the critical role of oxidative stress and secondary renal inflammation in severe burn-induced early AKI, a protective role of ATX through its anti-inflammatory effects and potential mechanisms of action in early post-burn AKI is reasonable.