Early hemodynamic profiles in severely burned patients: A single center cohort study

Large burns are associated with a massive inflammatory response and catecholamine release leading to complex cardiovascular disorders. Our aim was to describe the early hemodynamic trajectories following severe burns and to identify distinct hemodynamic trajectory patterns.

We retrospectively collected data from patients admitted to our burn center for severe burn injuries between January 2017 and April 2025. Hemodynamic data were obtained by transpulmonary thermodilution coupled with pulse wave analysis. Time series for cardiac index (CI), systemic vascular resistance index (SVRI) and heart rate (HR) were analyzed for the first 96 h. Hemodynamic profiles were compared using dynamic time warping (DTW). Clusters were identified through hierarchical clustering.

A total of 107 patients were included (median age 52 years [IQR: 36-65], median total burn surface area burned 40% [IQR: 30-54]); 22 patients died during their ICU stay. In the entire cohort, the hemodynamic profile progressively shifted from a low-cardiac output, vasoconstrictive state to a hyperkinetic, vasoplegic state (CI 2.6 ± 0.8-4.8 ± 1.3 L/min/m2; SVRI 3362[2659-4489] to 1382[1118-1698] dyn.s.cm^-5.m², p < 0.05). Cluster analysis identified two hemodynamic trajectory patterns, one with CI stabilization after an initial rise and another with a continuous increase in CI. SVRI decreased similarly in both clusters. ICU mortality differed between clusters in univariate analysis.

This study confirms a two-phase hemodynamic response to severe burns under active fluid resuscitation. It provides evidence for distinct hemodynamic trajectory patterns. These profiles could help optimize individual resuscitation strategies.