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BACKGROUND: Management of combat casualties with severe burns and associated traumatic injuries requires a coordinated interaction of surgical, critical care, and evacuation assets. These patients present enormous challenges to the entire medical system as a result of the severity of injury combined with the great distance required for transport to definitive care. OBJECTIVE: The objective of this study was to review and highlight some of the advances in burn critical care experienced during recent combat operations. This review focuses on initial resuscitation, respiratory support, care of the burn wound, and long range evacuation. DATA SOURCE: The authors conducted a search of the MEDLINE database and manual review of published articles and abstracts from national and international meetings in addition to Institute of Surgical Research Burn Center registry. CONCLUSIONS: Fluid resuscitation during the first 24 to 48 hrs after injury remains a significant challenge for all who manage burn casualties. Guidelines have been developed in an effort to standardize fluid resuscitation during this time. These guidelines along with the standardization of burn wound care and continued provider education have resulted in decreased morbidity and mortality in severely burned patients returning from war zones. This system of care for severely burned patients facilitates the transfer of the burn casualty between healthcare providers and facilities and is now being integrated into the catchment area for the Institute of Surgical Research Burn Center. [ABSTRACT FROM AUTHOR]

Rationale: Cytokines are central mediators of the immune-inflammatory response to injury and subsequent multiple organ dysfunction syndrome (MODS). Although previous studies evaluated cytokine levels after trauma, differences between patients with burn and non-burn trauma have not been assessed systematically.Methods: A prospective database of trauma patients admitted between May 2004 and September 2007 to the burn or surgical intensive care units within 24 h of injury with an anticipated stay of at least 72 h was analyzed. Sequential clinical and laboratory parameters were collected in the first week, including multiplex analysis data for plasma levels of inflammatory cytokines (IL-6, and IL-8). Patients with known pre-injury coagulopathy were excluded. A Marshall score of 10 or greater was defined as MODS.Results: A total of 179 patients were enrolled (67 burn and 112 non-burn). Plasma IL-6 and IL-8 levels were markedly elevated in both burn and non-burn patients compared to healthy volunteers. Burn subjects had higher levels of IL-6 and IL-8 than the non-burn on days 1 through 7 after injury. Subjects with burns and at least 30% total body surface area were older and had a lower injury severity score, a higher prevalence of MODS, and correspondingly higher mortality. Multivariate analysis of injury type, MODS, and time did not demonstrate an influence of MODS.Conclusions: Burns were associated with a greater and more sustained immune-inflammatory response than non-burn trauma as evidenced by elevated plasma IL-6 and IL-8 levels during the first week. There was no association between MODS and plasma cytokine levels. [ABSTRACT FROM AUTHOR]