Abstract 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.
Hypertrophic burn scars are associated with significant functional impairment and psychosocial morbidity. While fractional CO2 laser therapy has demonstrated efficacy in improving scar quality and symptoms, limited data exist on how baseline scar characteristics and patient factors influence treatment response. This study evaluated whether baseline scar severity, total body surface area (TBSA), and duration of initial hospital stay predict responsiveness to fractional CO2 laser therapy, and whether laser treatment is associated with a reduced need for scar contracture release procedures. A retrospective cohort study was conducted including patients with burn injuries who underwent fractional CO2 laser therapy. Scar severity was assessed using the Vancouver Scar Scale (VSS) before and after treatment. Additional variables included TBSA, length of initial hospitalization, and incidence of subsequent scar contracture release procedures. A control cohort of patients with burn injuries who did not receive laser therapy was included for comparison. Statistical analyses were performed to identify predictors of scar improvement and associations with procedural outcomes. Baseline VSS score was the strongest predictor of treatment response, with higher initial severity associated with greater improvement following laser therapy. Total body surface area and hospital length of stay were not significantly associated with treatment response. Laser therapy was associated with fewer scar contracture release procedures; however, this did not reach statistical significance, likely due to limited sample size. These findings suggest initial scar severity is a key determinant of laser responsiveness and support further study in larger cohorts.
Burn injuries are a leading cause of death and disability worldwide, disproportionally impacting pediatric patients. Many affected children will develop hypertrophic scarring, limiting activity, restricting range of motion, and negatively impacting psychosocial development. Although laser therapy is a routine treatment for hypertrophic burn scars in children, there is no consensus on the best anesthetic technique. In this multicenter retrospective cohort study, we aimed to identify effective anesthetic strategies that correlated with outcomes for pediatric laser scar therapy. We characterized perioperative anesthetic approaches for pediatric patients with burn scars who were undergoing laser therapy at 2 academic centers from 2020 to 2023. Among 239 encounters for 98 patients, intraoperative/postoperative opioids were given in 53% of encounters. Preoperative opioid use was associated with 86% lower odds of intraoperative/postoperative opioid administration (OR, 0.14; 95% CI, 0.06-0.34; P < .001). A 2-fold increase in total body surface area treated was associated with a 32% increase in the odds of opioid use (OR, 1.32; 95% CI, 1.11-1.58; P = .002) and 23% greater odds of pain (OR, 1.23; 95% CI, 1.05-1.43; P = .009) when controlling for other variables. Laser type was associated with a 2-fold higher odds of pain (OR, 2.11; 95% CI, 1.07-4.14; P = .030), and the incidence of emergence delirium was low (2.5% of the cohort). Differences in laser type and anesthetic management also varied across institutions, which impacted pain and recovery. These findings uncovered key patient and procedure factors that can inform standardized anesthetic guidelines for pediatric laser scar therapy.
ABSTRACT The implementation of near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) has seen a rising implementation in burn care in recent years, with expanding clinical indications and increasing evidence supporting its use. A systematic review was carried out following PRISMA guidelines, employing PubMed, Web of Science, CINAHL, and EMBASE databases to locate studies on the perioperative use of ICG in burn patients. Two independent reviewers assessed all articles for eligibility based on predefined inclusion criteria. Extracted data included study characteristics, patient demographics, clinical indications, ICG dosing regimens, administration timing, and reported perioperative outcomes. A total of 12 studies enrolling 204 burn patients, published between 1995 and 2025, were included for qualitative synthesis. Of these, 7 (58.3%) were prospective, single-center experimental studies; 3 (25%) were prospective, multicenter, blinded trials; 1 (8.3%) was a retrospective study; and 1 (8.3%) was a case series. The primary clinical uses of ICG in burn management included: assessment of burn depth reported in 6 studies, intraoperative delineation of necrotic tissue requiring excision in 3 studies, utility of ICG in liver function measurement in 2 studies and another research analyzed the estimation of plasma volume in burn patients. ICG fluorescence imaging is a promising adjunctive tool for burn assessment, particularly in identifying non-perfused tissue. It enhances the ability to accurately assess burn depth and helps to determine surgical margins during burn excision. Furthermore, ICG pharmacokinetics may provide insight into liver involvement and prognostic outlook in severe burn cases. However, its current role remains complementary to clinical evaluation. Further standardized and high-quality studies are required to define its diagnostic accuracy and clinical impact.
Abstract The global demographic shift toward an aging population is transforming burn care, yet the “oldest old” (adults ≥80 years) remain poorly understood. Standard geriatric guidelines are not specific to this subgroup, a group exhibiting unique physiological needs and vulnerabilities. We conducted a retrospective analysis of the Burn Model System (BMS) National Database for adults aged 80 years or older (N=104).1 Physical Function, Ability to Participate in Social Roles, and Pain Interference were assessed at 6 and 12 months post-burn and compared to pre-burn and US population norm (aged ≥75 years) data. Despite sustaining moderate injuries (Mean TBSA: 11.7%), our cohort required prolonged hospitalization (Mean: 26.9 days). We identified a functional recovery paradox: while Physical Function scores were low (40.1) at 12 months, Social Roles scores were average (50.0 at 6 months and 51.9 at 12 months). Notably, referral to inpatient rehabilitation (IPR) was highly variable (8.6% to 42.1%) and correlated strongly with social support; patients living alone were three times less likely to receive IPR than those with co-habitants (17.7% vs 61.7%). In conclusion, burn survivors aged 80 years and older face persistent reduction in physical function but demonstrate resilience in maintaining social roles, suggesting that slow physical recovery does not preclude quality of life. Prolonged acute hospitalizations and variable IPR access highlight the need for geriatric-specific guidelines to address the unique physiological, social, and systemic barriers that challenge the "oldest old."
