Early Haemadsorption in Major Burns

Major deep burns (>20% body surface, involving deep skin layers) and associated severe inflammatory reaction and their complication are one of the biggest challenge of intensive care. Haemoadsorption therapy, including the CytoSorb treatment is a promising novel therapeutic approach, but only case-studies are available in the literature yet. Based on data from septic shock patient treatment the investigators hypothesize that CytoSorb is beneficial in early treatment of burns. The investigators aim to conduct a randomised-controlled study to assess the clinical effectiveness (based on score systems including MODS, SOFA, APACHE II, KDIGO, ABSI), 7 and 28 days survival, intensive care length of stay, length of mechanical ventilation, resuscitation fluid need and ino/vasopressor drug doses and the presence and severity of organ dysfunctions, particularly renal dysfunction. The investigatora plan to conduct basic research to elucidate the pathophysiological background of clinical effect, including the measurement of inflammatory and anti-inflammatory cytokines, presence and severity of oxidative stress (lipid peroxidation, protein oxidation, reduced/oxidised glutathion levels) and organ dysfunction markers (kidney injury molecule -1, neutrophil gelatinase-associated lipocalin, cystatin-C, uromodulin).

Burns, Multiple Organ Failure, Shock, Organ Dysfunction Syndrome, Multiple, Renal Dysfunction, Cytokine Storm

Outcome assessors are unaware of the patient groups. Treated patients are not informed regarding randomisation results.

Patients are treated according to most recent guidelines in burn trauma and corresponding emergency and intensive therapy. All patients included are treated with early continous veno-venal renal replacement therapy.

Besides treatment strategies of the control group, the investigators start early haemadsorption treatment right after patient admission (and inclusion).

CytoSorb (Cytosorbents Inc.) aspecific blood purification device used in an extracorporeal circulation system without dialysis column. Anticoagulation is managed by siodium citrate-Calcium system, using the Gambro CVVHDF capable device.

The investigators assess the course of pro- and anti-inflammatory cytokines during ICU stay for both patient groups. Cytokines are screened by the Human Cytokine Array. Selected markers are measured individually.

Samples are gathered on inclusion and 8, 16, 24, 48, 72, 96, 120, 148, 168 hours following. Measured data points are selected by screening. All measurements are carried out in one lot. Data will be presented in arbitrary units.

Samples are gathered on inclusion and 8, 16, 24, 48, 72, 96, 120, 148, 168 hours following. Measured data points are selected by screening. All measurements are carried out in one lot.

Length of intensive care for each patient (days), data is registered through ICU discharge of the patient, an average of 1 month.

Length of mechanical ventillation (days). Data is registered through patient discharge from ICU, an average of 1 month.

Inclusion Criteria: informed consent of our patient or next of kin, TBSA >20% with 2/b depth of burn Exclusion Criteria: non-thermal burn injury, need for acute haemodialysis (intoxication), immunosuppressive treatment, chronic steroid use (> 3 months), known malignant disease, end-stage renal insufficiency or renal transplantation, Child C hepatic cirrhosis, gravidity, potentially lethal burn (Baux index >120) or comorbidities

The investigators plan to share patient clinical data and laboratory measurement results following study result publication.