Assessing Neonatal Opioid Withdrawal Syndrome Severity as a Function of Maternal Buprenorphine Dose and Umbilical Cord Tissue Concentrations.

BACKGROUND: Infants born to mothers with opioid use disorder (OUD) and prenatally treated with buprenorphine have a significantly lower incidence of neonatal opioid withdrawal syndrome (NOWS), its treatment duration, and hospital length of stay compared with methadone. However, risk of NOWS remains and clinicians continue to lack an objective methodology to predict NOWS severity among these infants. OBJECTIVE: The purpose of this study was to assess the relationship between buprenorphine exposure, umbilical cord tissue (UCT) concentrations, and NOWS development and severity. METHODS: A single-center retrospective observational cohort study from March 2018 through June 2020 of newborns exposed to buprenorphine in utero. Associations between quantified buprenorphine exposure, neonatal UCT concentrations, NOWS diagnosis, and severity were made using regression analyses. RESULTS: A total of 24 mothers and 25 neonates were included. Length of maternal buprenorphine therapy (months) positively correlated to norbuprenorphine (r2 = 0.234, P = 0.019) and buprenorphine + norbuprenorphine UCT concentrations (r2 = 0.203, P = 0.031). A positive relationship was seen between active metabolite concentrations and cumulative morphine dose (mg/kg) for treatment of severe NOWS (r2 = 0.471, P = 0.007). A 0.36 ng/g buprenorphine + norbuprenorphine UCT (CI = 0.002-0.72, P = 0.049) equated in a 1-point increase in modified peak Finnegan score. CONCLUSION AND RELEVANCE: Buprenorphine and norbuprenorphine UCT concentrations can allow for quantification of in utero fetal exposure and demonstrate an association with a longer duration of exposure with the severity and treatment of NOWS in exposed infants.

Continuous Venovenous Hemofiltration is Associated with Improved Survival in Burn Patients with Shock: A Subset Analysis of a Multicenter Observational Study.

INTRODUCTION: Acute kidney injury (AKI) is associated with high mortality in burn patients. Previously, we reported that timely initiation of renal replacement therapy (RRT) with an individualized preference toward continuous modes at relatively higher than recommended doses has become standard practice in critically ill burn patients with AKI and is associated with a historically low mortality. The purpose of this cohort analysis was to determine if modality choice impacted survival in burn patients. METHODS: After Institutional Review Board approval, a subset analysis was performed on de-identified data collected during a multicenter, observational study. All patients (n = 170) were 18 years or older, admitted with severe burn injuries and started on RRT. Comparisons were made utilizing χ2 or Fisher's exact test. Kaplan-Meier plots were utilized to assess survival. Sample size determinations to aid future research were calculated utilizing χ2 test with a Yates Correction Factor. RESULTS: Demographics and revised Baux were similar between groups. When continuous venovenous hemofiltration (CVVH) was compared to all other modalities, there was no statistically significant difference in survival (56 vs. 43%, p = 0.124). However, survival was significantly improved (54 vs. 37%, p = 0.032) in the subset of patients requiring vasopressors (n = 77). There was no statistically significant survival difference in patients with inhalation injury (38 vs. 29%, p = 0.638) or acute lung injury/acute respiratory distress syndrome (51 vs. 33%, p = 0.11). DISCUSSION/CONCLUSION: Survival may be improved if CVVH is chosen as the preferred modality in burn patients with shock and requiring RRT. Differences in other subsets were promising, but analysis was underpowered. Further research should determine if modality choice provides survival benefit in any other subset of burn injury.

Heterotopic ossification: a preventable case of gossypiboma in spinal cord injury.

OBJECTIVE: Heterotopic ossification is the formation of ectopic bone in soft tissues. It has three established aetiologies: genetic, traumatic and neurogenic. A gossypiboma is defined as a retained foreign body, such as a mass or sponge, usually after a surgical procedure. In this article, we present a unique, preventable case of a patient admitted for newly developed heterotopic ossification in the gluteus maximus muscle caused by a retained piece of foam from negative pressure wound therapy (NPWT). The heterotopic ossification lesion, together with the retained foreign body, was completely excised and reconstructed using a posterior thigh fasciocutaneous advancement flap. This is the first reported case of heterotopic ossification caused by a retained foreign body and may be helpful to better understanding of the aetiology of heterotopic ossification.

Incidence of Hypoglycemia in Burn Patients: A Focus for Process Improvement.

Background: Glycemic control in burn patients is critical for reducing infection and mortality. Objective: This study was conducted to assess the incidence and outcomes of hypoglycemia during continuous insulin infusions (CII). Methods: This institutional review board-approved study was a retrospective, single burn center, electronic chart review. Patients admitted between January 1, 2013, and October 31, 2014, who received a CII were included. Patients with incomplete data or who received <24 hours of CII were excluded. Results: Thirty-eight patients met inclusion criteria; 6 were excluded. The average patient was a 52-year-old Caucasian male with a 33% total body surface area burn and an acute physiology and chronic health evaluation (APACHE) II score of 20.Hypoglycemia was present for 87 of 6540 hours of CII therapy (1.1%). Two-thirds experienced a serum glucose <70 mg/dL and half <60 mg/dL. The most commonly assessed reasons for the hypoglycemic episodes were protocol violations (47%) and glucose variability (30%). After multivariable logistic regression, only history of diabetes remained a statistically significant risk factor with an odds ratio of 15.4 (95% confidence interval: 2.5-95.1). Four different CII protocols were prescribed. All protocols had a high glucose variability, as assessed by hours / day within goal range (13.1 ± 2.5, 14.1 ± 3.1, 14.3 ± 2.4, 9.8; P = .282). Conclusion: The amount of different protocols likely contributed to protocol violations and glucose variability. Our data demonstrate the need to create and consolidate usage to a single protocol in attempts to improve glycemic control.

Linezolid bladder irrigation as adjunctive treatment for a vancomycin-resistant Enterococcus faecium catheter-associated urinary tract infection.

OBJECTIVE: To describe the first reported successful use of adjunctive linezolid bladder irrigation. CASE SUMMARY: An 89-year-old woman with 10% TBSA burns developed septic shock and anuric acute kidney insufficiency. She acquired a urinary tract infection caused by vancomycin-resistant Enterococcus faecium (VREfm). Based on clinical status, a linezolid bladder irrigation was initiated in addition to high-dose intravenous linezolid and demonstrated microbiological cure with 7 days of treatment. DISCUSSION: Linezolid is primarily hepatically cleared and has no labeled indication for urinary tract infections. Anuria adds an additional complication of potentially reduced urinary drug concentrations. Bladder irrigation offers the benefit of achieving high local drug concentrations, but there are no data regarding such a route for linezolid. This case report is the first demonstrating the use, stability, safety, and efficacy of linezolid as a continuous bladder irrigation. CONCLUSIONS: Linezolid use as a bladder irrigation may be a feasible route of administration in anuric, critically ill patients with VREfm and few antimicrobial options. Further studies are warranted.

Retrospective analysis of pathogens for guided creation of an EMPIRic antibiotic prEscribing pathway (EMPIRE).

The objective of this study was to evaluate the susceptibilities of pathogens isolated from cultures within the first 7 days of admission to the burn center and in the absence of healthcare-associated infection risk factors (HAIRF) to determine if current empiric antibiotics can be narrowed for refinement of an empiric antibiotic prescribing pathway according to suspected source. A 3-year sample of patients and cultures was utilized in hopes of obtaining at least 30 isolates of the most common pathogens and their respective susceptibilities. Two-hundred and sixty-eight clinically-relevant (e.g., deemed infectious, versus colonization) pathogens were included in the final sample with sources including wounds, respiratory, blood, urine, and bone. Of the 268 pathogens included, 45% were Gram-negative and 69% of all pathogens were isolated from wound cultures. The existing empiric pathway, vancomycin plus cefepime, covered 98% and 84% of all Gram-positive and Gram-negative pathogens, respectively. In patients without HAIRF, coverage rose to 98% and 90%, respectively. Initial use of vancomycin and cefepime remains adequate for pathogens isolated within one week of admission in patients without HAIRF. For pneumonias, a narrower spectrum beta-lactam would not sufficiently cover respiratory pathogens isolated within the first week of admission. Regarding early wound infections, difficult-to-treat pathogens remain as a rare isolate of wound cultures within one week of admission.

Retrospective Review of Outcomes Related to Early Therapy Intervention Following Application of Cultured Epidermal Autografts in Severely Burned Patients.

Cultured epidermal autografts (CEA) have since become more prevalent in the treatment of burn-injured patients with limited available donor sites for adequate wound closure, resulting in decreased mortality rates and an increased number of these patients requiring burn therapy services to achieve optimal functional outcomes at discharge. However, the use and postoperative management of CEA continues to be controversial due in large to the physiological fragility and expense of CEA, leading to variable postoperative treatment practices across burn centers. As such, minimal research is available regarding patient outcomes following CEA application, specifically related to burn therapy intervention. Thus, a retrospective chart review was conducted on a series of 10 patients, 18 years of age or older, admitted to a single, American Burn Association (ABA) verified burn center, between April 2015 and April 2023, who required CEA, and received pre- and postoperative treatment by burn therapists in accordance with center-specific burn rehabilitation guidelines. The resulting patient outcomes, in response to early implementation of therapy interventions post-CEA surgery, demonstrated optimal functional status for patients upon discharge, and positive long-term implications.

Inhalation Injury, Respiratory Failure, and Ventilator Support in Acute Burn Care.

Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.

Pharmacokinetic Analysis of Intravenous Push Cefepime in Burn Patients with Augmented Renal Clearance.

Patients with augmented renal clearance (ARC) are a subset of critically ill patients including burn patients that exhibit increased renal elimination of medications beyond that of similarly injured patients. Currently approved maximum regimens of medications primarily eliminated by the kidney, such as cefepime (>90% unchanged in the urine), may be inadequate (eg, compromising the bactericidal activity of cefepime) in patients with ARC. Due to recent resource limitations, centers have changed infusion practices of commonly prescribed medications to intravenous push (IVP), potentially exacerbating the problem of maintaining bactericidal cefepime concentrations. The hypothesis of the study was patients with ARC are not currently achieving adequate target attainment, when receiving cefepime 2 g every 8 h IVP. Eight blood samples were collected from each patient, and concentrations measured via LC-MS/MS. WinNonlin (version 8.3) was used to estimate the pharmacokinetic parameters of cefepime and simulate plasma concentrations of cefepime in each of the ten subjects. Simulations of cefepime plasma concentrations produced by a 2 g dose given every 8 h and a 1 g dose given every 4 h were performed and the time above a MIC of 4 mg/L, 8 mg/L, and 16 mg/L compared. The 2 g every 8 h regimen remained above the breakpoints for 92%, 85%, and 71% of the dosing interval, respectively. The 1 g every 4 h regimen remained above the same breakpoints at a frequency of 100%, 99%, and 92% of the dosing interval. Giving cefepime 1 g every 4 h is a simple approach to increase the likelihood of maintaining the optimal bactericidal activity of cefepime in patients with ARC.

Vitamin D Deficiency Is Associated With Increased Length of Stay After Acute Burn Injury: A Multicenter Analysis.

In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis and infectious complications. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). This was a multicenter retrospective study of adult patients at 7 burn centers admitted over a 3.5-year period, who had a 25-hydroxyvitamin D concentration drawn within the first 7 days of injury. Of 1147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, P < .001), acute kidney injury (AKI) requiring renal replacement therapy (7.3 vs 1.7%, P = .009), more days requiring vasopressors (mean 1.24 vs 0.58 days, P = .008), and fewer ventilator-free days of the first 28 days (mean 22.9 vs 25.1, P < .001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, vitamin D deficiency was associated with longer LOS. In conclusion, patients with thermal injuries and vitamin D deficiency on admission have increased LOS and worsened clinical outcomes when compared with patients with nondeficient vitamin D concentrations.

An Appraisal of Pharmacotherapy-Pertinent Literature Published in 2021 and 2022 for Clinicians Caring for Patients With Thermal or Inhalation Injury.

Studies focusing on pharmacotherapy interventions to aid patients after thermal injury are a minor focus in burn injury-centered studies and published across a wide array of journals, which challenges those with limited resources to keep their knowledge current. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Twenty-three geographically dispersed, board-certified pharmacists participated in the review. A Medical Subject Heading-based, filtered search returned 2336 manuscripts over the previous 2-year period. After manual review, 98 (4%) manuscripts were determined to have a potential impact on current pharmacotherapy practice. The top 10 scored manuscripts are discussed. Only 17% of those reviewed were assessed to likely have little effect on current practice. The overall impact of the current cohort was higher than previous editions of this review, which is encouraging. There remains a need for investment in well-designed, high-impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.

State and Future Science of Opioids and Potential of Biased-ligand Technology in the Management of Acute Pain After Burn Injury.

Pain associated with severe burn injury is one of the most intense and clinically challenging to manage, as the metabolic imbalances associated with the inflammation caused by the injury and treatment interventions (e.g., dressing changes and debridement, excision, and grafting) can further worsen the pain. In the pharmacologic management of a complex, hospitalized patient with burn injuries, opioid therapy remains an efficacious mainstay of treatment. However, the complex nature of pain, injury characteristics, and common demographics after burn injury place patients at high risk of opioid-related adverse events. Thus, guidelines recommend that decisions about choice of opioid be based on physiology, pharmacology, and physician experience, in addition to individualizing initial treatment with subsequent continual adjustments throughout care. Although substantial progress has been made in pain management strategies with utilization of nonopioid medications and nonpharmacologic adjuncts to opioid pharmacotherapy, there is still a need to evaluate new therapies, as an optimal regimen still lacks significant evidential support. Herein, we review the actions of opioids at the cellular level, contributing to both nociception and opioid-related adverse events. We also discuss the most recently approved intravenously administered opioid, oliceridine, developed utilizing biased ligand technology, including a summary of its clinical efficacy and safety in the management of severe acute pain. While oliceridine has been evaluated for the management of moderate-to-severe acute pain, the large phase 3 studies did not include patients with burn injuries. However, potential implications and future study direction for pain associated with burn injury are discussed.

Deficiencies of Rule-Based Technology-Generated Antibiograms for Specialized Care Units.

The objective of this study was to compare the pathogens and susceptibilities of the current automated, rule-based technology (RBT) antibiogram with one manually collected through chart review with additional rules applied. This study was a two-year, retrospective cohort study and included all bacterial cultures within the first 30 days from patients admitted to a single Burn Center. The current RBT antibiogram served as the control, and new antibiogram versions were created using additional rules and compared to the control. Six-hundred fifty-seven patients were admitted (61% excluded for lack of cultures). 59% had at least one hospital-acquired risk factor, with over one-third having recent illicit drug use and one-third having a recent hospitalization. Of the 410 cultures included, 57% were Gram-negative, and half were from wound infections. Sensitivities were significantly different when comparing the manual and the RBT version after including factors such as days since admission, presence of hospital-acquired risk factors, or previous antibiotic courses. Recommended empiric Gram-negative antibiotics changed from double coverage to a single ß-lactam with >90% susceptibility. The susceptibilities between the first and subsequent courses were dramatically different. Before developing an antibiogram or interpreting the output, it is important to consider which automated criteria are utilized, especially for units with extended lengths of stay.

A Risk-Benefit Review of Currently Used Dermal Substitutes for Burn Wounds.

While split-thickness autologous skin grafts remain the most common method of definitive burn wound closure, dermal substitutes have emerged as an attractive option. There are many advantages of utilizing a dermal substitute, notably reducing the need for donor tissue and subsequent iatrogenic creation of a secondary wound. However, there are disadvantages with each that most be weighed and factored into the decision. And most come at a high initial financial cost. There is little comparative literature of the various available and emerging products. This analysis was performed to objectively present risks and benefits of each option.

A Comprehensive, Retrospective Analysis of Variables for Potential Mortality Impact in Patients With Thermal or Inhalation Injury.

Age, percentage TBSA burned, and the presence of inhalation injury have been used historically in the prediction of mortality in thermally injured patients despite other factors being also associated with mortality. Recent literature has identified novel factors associated with increased length of stay (LOS) and may provide a better prediction model for mortality in burn patients. The study objective was to perform a subset analysis of a multitude of known and novel variables for potential association with mortality. Demographics and injury characteristics along with during stay variables were collected and analyzed. This study is a re-analysis of a retrospective study examining variables associated with increased LOS. Of the 629 patients screened, 396 were included in the analysis. After univariable analysis, 35 variables had significant associations with mortality, including age, house fire, acute kidney injury, heart failure, inhalation injury, and history of diabetes. After multivariable analysis, the best performing model included heart failure, acute kidney injury, admission Glasgow Coma Scale score, and revised Baux score. Quantile analysis of age revealed greater than 60 years was most predictive of mortality. The best multivariable model for patients greater than 60 years old included heart failure, vasopressor use, acute respiratory distress syndrome, and TBSA burned. Considering only variables present on admission, the best multivariable model for patients greater than 60 years old included heart failure, % TBSA burned, and inhalation injury. The addition of variables into current prediction models and databases may be warranted.

Efficacy of a Novel LAM Femoral Cutaneous Block Technique for Acute Donor Site Pain.

Patients with severe burn injuries often require split-thickness skin grafting to expedite wound healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Peripheral nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary. The purpose of this case series is to assess the safety, feasibility, and clinical efficacy of a recently demonstrated novel continuous LAM (lateral, anterior, medial) femoral cutaneous block technique in a larger cohort. The study was a dual IRB approved, observational case series from a single verified burn center. The electronic health record was retrospectively reviewed for patients admitted between June 2018 and May 2021 who had the continuous LAM block performed for donor site pain by the acute pain service team. Demographics were reported with descriptive statistics and morphine milligram equivalents (MME) were analyzed via Friedman analysis of variance. Forty-seven patients had a total of 53 blocks placed, where 2 patients received the LAM block on two separate occasions and 4 patients had bilateral LAM blocks placed. Most were African-American males, but mechanism of injury varied. Over half had a neurologic (17%) or psychiatric history (34%) outside of substance use. Almost three-quarters had a history of substance use with 17% being opioids, and a quarter had a history of polysubstance use. Median day from admission to LAM was 7 (2.5, 11.5) with a median duration of 4 (3, 5) days. Temperature and pressure sensation were reduced at the donor site. Quadricep strength remained intact, and median day until first ambulation after LAM placement was 2 (1, 3) days. Pain was adequately controlled, and there were no significant adverse events associated with the block. There was a significant reduction in MME after block placement (p < .001). Continuous peripheral nerve blocks offer an advantageous means of analgesia, while reducing potential adverse events associated with opioids or multimodal regimens. The novel LAM technique reduced sensation and pain without inhibiting early ambulation, and patients were able to fully participate in their rehabilitation.

A Retrospective Chart Review to Determine Hypophosphatemia Incidence and Phosphorus Supplementation Requirements in Patients With Severe Thermal Cutaneous Injuries Receiving High-Volume Hemofiltration.

Patients with severe thermal injuries have increased metabolic demands necessitating frequent phosphate supplementation. Patients with acute renal failure may have less requirements, due to reduced elimination. However, patients being supported with renal replacement therapy have varying degree of requirements. Little published evidence depicts the incidence of hypophosphatemia and repletion requirements in patients with severe thermal injuries treated with high-volume hemofiltration (HVHF) and a high-flux membrane. The objective of this retrospective chart review was to determine the incidence of hypophosphatemia and characterize repletion requirements and response in this population. Enrolled patients had at least 20% TBSA thermal injuries and required continuous hemofiltration with prefilter replacement fluid doses ≥35 mL/kg IBW/hr. A randomly selected cohort without acute kidney injury (AKI) and matched based on age and extent of TBSA was used to compare phosphorus requirements over an initial 14-day period. Demographics, diet, and variables affecting phosphorus concentrations were collected. Sixteen patients were included in the retrospective HVHF group and 16 patients in a case-control cohort to better depict the impact of HVHF. The average age was 60.2 ± 15.1 years and median TBSA was 30% (23.4, 56.3) in the HVHF group, compared to 53.3 ± 16.4 years (P = .22) and TBSA 29% (26.4, 33.9; P = .73). All patients in the HVHF group were started on HVHF with a 1.6 m2 polyethersulfone membrane for AKI. As expected, the HVHF group exhibited statistically higher than normal baseline potassium and phosphorous laboratory values. The HVHF group experienced more days with hypophosphatemia (49.6 ± 12.4% vs 29.3 ± 16.3%, P = .012), despite 0.75 mmol/kg/day phosphorous supplementation (compared to 0.66 mmol/kg/day for the control group, P = .45). Patients with longer durations of HVHF therapy experienced increasing risk of hypophosphatemia, reaching 100% by the end of the study period. This study demonstrates severe thermally injured patients receiving HVHF for AKI are at increased risk for hypophosphatemia, and require high phosphate supplementation.

A Regional Analysis of Potentially Preventable Injuries Sustained From Burning Garbage and Yard Waste.

Due to high prevalence in the south, understanding the injury pattern, healthcare burden, and cost of burn injuries associated with burning yard and trash debris are important for effective prevention. This 5-year retrospective, single-center study included patients sustaining an open flame burn injury due to burning brush or trash. Based on primary residence of the 136 patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment, and 18% did not have access. The median (Q1 and Q3) age and total body surface area (TBSA) burned was 50 (32, 66.5) years and 5% (2.5, 12), respectively, with 36% having some portion of full-thickness injury. One-third had some form of substance use. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 hospital days utilized (~6.6% of available bed-days per study period). Twenty-five percent were discharged with a paired functional status worse than pre-injury. Patients with some degree of pre-injury function limitations had a 3-fold higher length of stay (10 vs 3 days; P = .023). Patients with lower pre-injury functionality had almost four times higher mortality (23.7% vs 6.3%; P = .085). There were 9 (6.7%) deaths with an average (±SD) of 74.3 ± 13.1 years of age, median of 33% (31, 43) TBSA, and median full-thickness TBSA of 32% (21, 44). Total hospital charges exceeded $32.6 million with a median of $32,952.26 ($8,790.48, $103,113.95) per patient. Focusing future outreach efforts on education and resource availability may prevent future waste-burning injuries.

American Burn Association (ABA) Burn Care Quality Platform (BCQP) and Large Data Set Analysis Considerations: A Practical Guide to Investigating Clinical Questions in Burns via Large Data Sets.

The Burn Care Quality Platform (BCQP) consolidates data previously collected from the National Burn Repository and the Burn Quality Improvement Program into a single registry. Its data elements and their associated definitions are tailored to create consistency across other national trauma registries, namely the National Trauma Data Bank implemented by the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP). The BCQP now includes 103 participating burn centers and has captured data from 375,000 total patients as of 2021. With 12,000 patients entered under the current data dictionary, the BCQP represents the largest registry of its kind. On behalf of the American Burn Association Research Committee, the aim of this whitepaper is to provide a succinct overview of the BCQP, showcasing its unique features, strengths, limitations, and relevant statistical considerations. This whitepaper will highlight the resources available to the burn research community and offer insight on proper study design when preparing to conduct a large data set investigation for burn care. All recommendations herein were formulated through the consensus of a multidisciplinary committee and based on the available scientific evidence.

Surviving Sepsis After Burn Campaign.

INTRODUCTION: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS: The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.