Lucy Wibbenmeyer

Despite advances in burn care, the pain of burn treatment remains unresolved. The creation of donor harvest sites is often unavoidable, and the subsequent pain is difficult to treat. Regional anesthesia for the donor harvest sites can provide effective analgesia, however, there is limited literature regarding its efficacy. The purpose of this study was to assess the use of regional anesthesia for donor harvest site pain. Patients admitted to the burn center from January 1, 2011, to May 15, 2025, with thigh donor site harvest(s) were reviewed for study inclusion. Data collected included demographics, burn variables, hospital course data, and regional anesthesia procedure details. Descriptive statistics were used to determine differences between the block and non-block groups. Of the 524 patients included, 164 (31.3%) had donor site blocks and 360 (68.7%) did not. There were 77 (47%) with single shot blocks and 87 (53%) had indwelling catheters (groin or epidural). The groups were well-matched in their demographics, burn injury data, and hospital variables. The overall oral morphine equivalents (OME) and pain report levels were similar between the block and control groups in all three post-operative periods. However, causal conclusions are limited by this retrospective, heterogenous study. An appropriately protocolized prospective study is planned.

Critical illness-related corticosteroid insufficiency (CIRCI) presents as refractory hemodynamic shock in critically ill patients. Research on CIRCI and its treatment in burn patients is limited. We sought to review the use of corticosteroids in a burn population during their first week of hospitalization. The burn registry and the electronic medical records were queried for burn patients admitted between January 2015 and December 2025. The following variables were abstracted: demographics, burn history, hospital course, and treatments. Outcome variables included length of stay (LOS), infections, graft loss, pharmacological treatment, and mortality. The two groups were compared with Student’s T-test and Chi Square where appropriate. A multivariant analysis was performed to determine independent predictors of CIRCI, infection and mortality. Significance was determined at p<0.05 level. The study group consisted of 87 patients in hemodynamic shock receiving vasopressors, with 47 also receiving corticosteroids. The corticosteroid group had larger burns (37.6 v 25.1%), more resuscitation (15.9 v 8.1 L), more vasopressor days (6.23 v 3.7 d), more ventilator days (19.72 v 7.83 d), more infections (66% v 34%) and longer LOS (51.53 v 26.05 d), all p<0.05. On multivariant analysis, variables independently related to the diagnosis of CIRCI were age and resuscitation fluids; to infection were corticosteroid use; and to mortality were age. Overall, over 50% of patients in hypotensive shock during their first week of treatment were diagnosed and treated with corticosteroids for suspected CIRCI. More study is needed to determine the appropriate role of corticosteroid use in early burn treatment.

Frostbite injuries can have lasting sequelae including amputations, intolerance to cold, chronic pain, paresthesia, and inability to return to work. Despite this morbidity, the treatment of frostbite remains understudied. The FRostbite ObServational Trial (FROST) aims to address this gap through a multicenter evaluation of treatment practices and outcomes. As part of FROST, we reviewed institutional frostbite care protocols from 16 participating sites across North America. Practices were categorized as demonstrating uniform agreement $\Big(\ge$90% mentioned the practice), consensus ($\ge$75%), or majority if ($\ge$50%). Uniform agreement was limited to use of rapid rewarming and thrombolytics, the latter being influenced by site selection criteria for FROST participation. Consensus was achieved in multiple areas (such as urgency of treatment, perfusion assessment, the therapeutic windows for pharmaceutical interventions, and the therapeutic dosing of IV thrombolytics). Protocols varied on grades for thrombolytic treatment initiation, prostacyclin analogue use, post-thrombolytic anticoagulation treatment and duration, the role of physical or occupational therapy, splinting, and appropriate wound care. This manuscript provides a synthesis of protocols and expert opinion for the acute management of frostbite injury. This synthesized protocol may serve as a tool for centers to develop their own standard protocol to facilitate care for frostbite patients. Additionally, current opportunities for frostbite research and improving care are detailed in the manuscript. Education regarding prevention of injury and the need for emergent treatment is needed for both the public and the medical community.

The American Burn Life Support course recommends fluid resuscitation of patients with TBSA ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that population. Patients with burns 15% to 19.9% TBSA admitted from January 1, 2019 to March 31, 2023 who received protocolized fluid resuscitation were included. Demographics, hospital course, and fluids received were reviewed. Fluid resuscitation was categorized as “below range” (Parkland formula [PF] < 3 mL/kg/%TBSA), “within range” (PF = 3-5 mL/kg/%TBSA or “above range” (PF > 5 mL/kg/%TBSA). Similarly, urine output (UOP) was expressed as “below range” (50 mL/h). The resuscitation groups were compared. P < .05 was considered significant. Thirty-three patients received resuscitation via Brooke (9.1%), PF (63.6%), or other formula (27.3%). Most were male (81.8%) with a median TBSA of 17%; median age was 57 years. Almost 20% of patients required vasopressors during resuscitation. Fifteen patients were within the predicated range of PF, 15 were under, and 3 were over. There was no difference between the groups with respect to demographics, burn injury variables, or complications. Notably, the average creatinine and lactate 24 h postadmission were 0.9 mg/dL and 2 mg/dL, respectively. Half of the study patients received greater than maintenance; all were in either the within burn resuscitation range or above range groups. This retrospective study suggests that patients with smaller burns may benefit from resuscitation as 50% received more than maintenance. Resuscitation of smaller burns requires more study.

Fires and burn injuries incurred from home oxygen therapy continue to pose a significant and escalating public health risk, particularly as the population of older adults ≥ 65 years exponentially grows during the next decades. In these oxygen-rich environments, common household ignition sources can trigger spontaneous fires that burn hotter and spread more rapidly. This endangers the patient, family members, neighbors, home healthcare workers, and first responders, potentially leading to property loss, injury, and/or death. A call to action was stimulated by a national review revealing a 14% per year increase in oxygen therapy injuries during a 10-year period. Similarly, the Veterans Health Administration issued a “Patient Safety Alert” due to the observed significant increase in oxygen therapy-related fires and injuries. To address this critical issue, professionals nationwide are seeking novel solutions to define the problem, raise awareness, and implement community-based risk reduction strategies. Hence, this article bridges an identified literature gap by providing a needed foundational overview of oxygen therapy-related fires and burn injuries, examining incidence data, illustrating current knowledge and data limitations, highlighting unique challenges, exploring opportunities for change, outlining ongoing national risk reduction efforts, and recommending specific evidence-informed strategic approaches for comprehensive prevention and mitigation interventions.

Introduction: Housefires can cause devastating injuries, disproportionately affecting low socio-economic communities. Applying geographic information system and spatial analysis, we examined the association between housefires and socio-economic variables from the area deprivation index (ADI) and social vulnerability index. Methods: Patients who sustained a burn injury from a housefire and were admitted to our burn unit between 2008 and 2023 were identified from our burn registry. Spatial binary logistic regression estimated the associations between social vulnerability factors and census tract housefires. Results: Multiple social vulnerability factors were associated with housefires with the final model, including fourth quartile of ADI (OR=5.9), percentage of black residents (OR=4.9) and mobile home residences (OR=2.5) compared with the first quartiles (p<0.05). Conclusion: Multiple housefires occurring in a census tract are associated with social vulnerabilities. Identifying census tracts with higher ADI, black resident ratios and mobile home ratios can help focus community interventions on high-risk areas. Further studies are needed to evaluate and refine the model and determine the current model’s predictive ability.

The incidence of admissions for burn and inhalation injuries related to home oxygen therapy remains poorly defined in the U.S. We analyzed the American Burn Association’s Burn Care Quality Platform (BCQP) database (2013-2022) to generate national estimates of supplemental home oxygen therapy-related injuries and outcomes. Text string extraction identified cases using multiple search permutations related to home oxygen use. Patient demographics, injury characteristics, and inpatient outcomes were described. Logistic regression assessed predictors of oxygen therapy injuries, and Poisson regression estimated adjusted incidence rates. Of 207 364 burn admissions, 79 114 (28%) contained injury descriptions, with 3.0% (2360 cases) attributed to home oxygen therapy. These patients had a median age of 65 years (IQR: 59-71), mean total body surface area (TBSA) of 4.1%, were predominantly male (62.6%) and white (79.0%). Medicare was the most common payer (57.7%). Inhalation injury was present in 11.4%, mean length of stay was 8 days, and inpatient mortality was 6.1%. Smoking was the leading ignition source (63%), followed by cooking/stove (4%), while 22% had no identified cause. The adjusted incidence rate of supplemental home oxygen injuries was 3.6% (95% CI, 2.7%-2.9%; P < 0.001), with a significant annual increase (incidence rate ratio: 1.03; 95% CI, 1.02-1.04). Oxygen therapy-related injuries account for 1088 (95% CI, 1065-1113) burn admissions per year in the U.S. Despite smaller TBSA burns, mortality was twice the national average for burn patients, and for survivors, the odds of discharge home were 15% less likely. Targeted prevention strategies are needed to mitigate this growing public health problem.

Unplanned extubation rates in burn patients were previously reported at 27% (3 cases per 100 ventilator days). As facial burns pose a unique challenge to tube securement, patients in our unit have surgically placed bite blocks to secure the endotracheal tube at the provider’s discretion. Herein, we assessed unplanned extubation rates at our burn center. We performed a retrospective cohort study including burn patients who required mechanical ventilation from 7/01/2015 to 6/30/2023. Demographics, comorbidities, injuries, and hospital course information were collected and compared between patients who had an unplanned extubation and those who did not. Binary logistic regression analyses were performed to identify factors associated with unplanned extubation and ventilator-associated pneumonia (VAP) complication. P < 0.05 was considered significant. Of 360 patients, 17 (4.7%) had unplanned extubations, representing 0.7 cases per 100 ventilator days. There were no significant differences in demographics, comorbidities, or burn injury characteristics between groups. Patients with unplanned extubation were more likely to have an inhalation injury (70.6% vs 42.6%, P = .001), paCO2 ≥ 50 (70.6% vs 39.1%, P = .031), more ventilator days (6 [2-15] vs 2 [1-4] days, P < .001), and more hospital days (14 [8.5-25.5] vs 8 [2-20], P = .020). Ventilator-associated pneumonia rate tended to be higher in the unplanned extubation group (17.6% vs 5.5%, P = .077). On multivariate analysis, inhalation injury was associated with an increased risk of unplanned extubation (odds ratio (OR) = 4.68 [1.59-13.81], P = .005). No patients with bite blocks had an unplanned extubation. Further study on the utility of advanced securement devices is recommended.

Cytokine storm can occur in many different clinical conditions and lack of recognition can lead to death. While cytokines have been measured and trended in burn patients, cytokine storm has not been widely discussed or its treatment reported. We present herein the diagnosis and the treatment of a 5-year-old, 91% burn patient, who developed cytokine storm 3 times during his hospital course. Aggressive treatment led to a successful resolution. Cytokine storm should be entertained in patients who develop classic storm signs and symptoms, along with supporting laboratory. Treatment should be tailored to the patients’ clinical picture. More study is warranted to define cytokine storm as well as its treatment in burn patients.