ASV and Targeted Fluid Resuscitation in Severe Burns

Severe burn injury is frequently associated with profound systemic inflammation, capillary leak syndrome, hypovolemic shock, inhalation injury, and acute respiratory failure requiring invasive mechanical ventilation. The first 72 hours following injury represent a critical phase during which both ventilatory support and fluid resuscitation substantially influence organ function and subsequent clinical outcomes.

Adaptive Support Ventilation (ASV) is a closed-loop mechanical ventilation mode that automatically adjusts ventilatory parameters according to the patient's respiratory mechanics while maintaining predefined ventilation targets. This approach has the potential to optimize lung-protective ventilation, reduce unnecessary ventilatory stress, and improve patient-ventilator synchrony. At the same time, targeted fluid resuscitation aims to individualize fluid administration based on physiological and clinical parameters in order to maintain adequate tissue perfusion while minimizing fluid overload and the development of burn-related edema.

This prospective cohort study will evaluate the association between the combined use of Adaptive Support Ventilation and targeted fluid resuscitation during the early management of adult patients with severe burn injuries admitted to the intensive care unit. Patients will be managed according to institutional protocols, and no study-specific interventions will be introduced beyond routine clinical practice.

Clinical, respiratory, hemodynamic, and laboratory data will be collected prospectively during the first 72 hours after intensive care unit admission. Ventilatory variables, oxygenation indices, respiratory mechanics, fluid administration, cumulative fluid balance, urine output, and organ dysfunction parameters will be recorded using standard monitoring systems and electronic medical records.

The study aims to characterize the physiological effects of early Adaptive Support Ventilation combined with targeted fluid resuscitation and to evaluate their association with respiratory function, fluid balance, and early clinical outcomes in patients with severe burn injury. The findings are expected to provide real-world evidence to support optimization of intensive care strategies for critically ill burn patients.

Inclusion criteria

• Adults aged 18 years or older.
• Hospital admission with severe burn injury involving ≥20% total body surface area (TBSA).
• Requirement for invasive mechanical ventilation within 24 hours after admission to the intensive care unit.
• Expected need for mechanical ventilation for at least 48 hours.
• Treatment with Adaptive Support Ventilation (ASV) and targeted fluid resuscitation according to institutional protocols.
• Written informed consent provided by the patient or legally authorized representative, in accordance with local regulations.

Exclusion criteria

• Age younger than 18 years.
• Burn injury involving <20% TBSA.
• Mechanical ventilation initiated more than 24 hours after ICU admission.
• Pregnancy.
• Pre-existing chronic dependence on invasive mechanical ventilation.
• Severe traumatic brain injury requiring a specific ventilation strategy.
• Terminal illness with an expected survival of less than 24 hours.
• Enrollment in another interventional clinical trial that may influence study outcomes.
• Inability to obtain essential clinical data required for study analysis.