# Comparative Analysis of Recent Burn Guidelines Regarding Specific Aspects of Anesthesia and Intensive Care

## TL;DR

This paper compares recent burn care guidelines and finds that while they agree on general principles, they differ in specific recommendations for anesthesia and intensive care.

## Contribution

The study identifies evidence gaps and inconsistencies in current burn care guidelines, particularly in airway management and pain strategies.

## Key findings

- All guidelines agree on early airway assessment but lack a strategy for identifying at-risk patients.
- Recommendations for fluid resuscitation vary in thresholds, volume, and adjuncts.
- Pain and procedural sedation management strategies are not uniformly detailed across guidelines.

## Abstract

Background: Critical care for patients with severe burn injuries is challenging, particularly in the first 24–48 h. Multiple guidelines exist but their recommendations vary in content and in the level of detail. Methods: This narrative review analyzed recent (last 10 years) adult burn guidelines in English, Dutch and German, sourced from PubMed, Medline and official burn society publications. The review focused on airway management, mechanical ventilation, fluid resuscitation, pain management and procedural sedation. Results: All guidelines emphasize early airway assessment and timely intubation in patients at risk for loss of airway patency; however, a strategy for analyzing patients at risk is lacking. Lung-protective ventilation strategy is generally recommended. Fluid resuscitation is the cornerstone during the first phase, though recommendations for thresholds, volume and adjuncts differ. (Chronic) pain management should be multimodal, combining pharmacologic and non-pharmacologic approaches, but specifics on choice of modality are limited, also, there is no uniform strategy for procedural sedation management. Conclusion: Current guidelines offer broadly consistent recommendations for initial burn care but differ in specifics, reflecting evidence gaps. Future guidelines should address advances in airway management, fluid resuscitation endpoints, volume and adjuncts, and give a more detailed (chronic) pain strategy to improve standardization and outcomes.