Burn Resuscitation

SOC → SCF-DBI Logic Translation

Purpose

Burn Resuscitation is the critical care process of restoring effective tissue perfusion, maintaining organ function, correcting intravascular volume depletion, and preventing secondary injury following major thermal injury.

Traditional burn resuscitation relies heavily upon formula-based fluid administration. However, severe burns produce profound endothelial dysfunction, capillary leak, inflammatory amplification, and microcirculatory collapse that extend beyond simple hypovolemia.

Under SCF-DBI, Burn Resuscitation is not merely replacement of fluid losses.

It is restoration of the Burn Microvascular Integrity Network (BMIN) through stabilization of endothelial function, preservation of tissue perfusion, control of inflammatory permeability, and prevention of secondary organ injury.

SOC Definition

Clinical Objective

Restore effective circulation to:

Maintain tissue perfusion
Correct burn shock
Preserve organ function
Prevent renal failure
Support oxygen delivery
Minimize under-resuscitation
Avoid fluid overload complications

Applicable Conditions

Major Thermal Injury

Examples:

Burns >20% Total Body Surface Area (TBSA) in adults
Burns >10–15% TBSA in pediatric patients
Extensive partial-thickness burns
Full-thickness burns

Inhalation Injury With Shock

Examples:

Combined thermal and inhalation injury
Burn-associated respiratory compromise

Electrical Burns

Examples:

High-voltage injuries
Deep tissue destruction
Myoglobinuria-associated shock

Delayed Burn Presentation

Examples:

Prolonged transport intervals
Under-resuscitated patients

SCF-DBI Translation

Core Concept

SOC views Burn Resuscitation as:

Fluid replacement to reverse burn shock.

SCF-DBI views Burn Resuscitation as:

Restoration of the Burn Microvascular Integrity Network through preservation of endothelial competence and adaptive perfusion.

The objective extends beyond fluid administration.

The objective is preservation and restoration of:

Endothelial integrity
Microvascular continuity
Tissue oxygen delivery
Organ perfusion
Inflammatory homeostasis
Metabolic resilience

SCF-DBI Burn Shock Failure Architecture

Domain 1

Burn Microvascular Integrity Failure

SOC Focus

Replace intravascular fluid deficits.

SCF-DBI Focus

Prevent collapse of the integrated endothelial–microvascular system.

Failure Cascade

Thermal injury

↓

Inflammatory mediator release

↓

Endothelial glycocalyx disruption

↓

Capillary permeability increase

↓

Plasma extravasation

↓

Microvascular dysfunction

↓

Burn shock

↓

Organ hypoperfusion

↓

Multiorgan dysfunction

SCF Classification

Burn Microvascular Integrity Failure Syndrome (BMIFS)

A state in which burn-induced endothelial dysfunction and capillary leak disrupt adaptive perfusion and threaten systemic recovery.

Output

Burn Shock Severity Score (BSSS)

Domain 2

Endothelial Leak Index

Major SCF-DBI Enhancement

Selected Enhancement:

Endothelial Leak Index (ELI)

This becomes the principal SCF-DBI enhancement for Burn Resuscitation.

Rationale

SOC evaluates:

Formula-derived fluid requirements
Urine output
Blood pressure
Heart rate

SCF-DBI evaluates:

Whether endothelial permeability is stabilizing or progressing toward persistent leak physiology.

The central question becomes:

Is fluid resuscitation restoring vascular competence, or merely compensating for ongoing endothelial failure?

Leak Failure Cascade

Endothelial injury

↓

Glycocalyx degradation

↓

Capillary leak

↓

Interstitial edema

↓

Increased fluid requirements

↓

Compartment burden

↓

Pulmonary dysfunction

↓

Organ compromise

Recovery Cascade

Resuscitation optimization

↓

Endothelial stabilization

↓

Reduced permeability

↓

Improved intravascular retention

↓

Microvascular recovery

↓

Edema resolution

↓

Physiologic resilience

Assessment Domains

Domain	Function
Fluid requirement trends	Leak burden
Net fluid balance	Retention efficiency
Serum albumin trajectory	Oncotic integrity
Hemoconcentration evolution	Plasma loss burden
Tissue edema progression	Leak manifestation
Vasopressor requirements	Circulatory competence

Leak States

State	Interpretation
Green	Endothelial recovery
Yellow	Moderate leak burden
Orange	Significant permeability dysfunction
Red	Progressive capillary failure

Output

Endothelial Leak Index (ELI)

Domain 3

Microcirculatory Recovery Intelligence

SCF-DBI Enhancement

Macro-hemodynamic normalization does not ensure tissue-level perfusion.

Assessment Domains

Domain	Function
Lactate clearance	Global perfusion recovery
Capillary refill	Microvascular adequacy
Peripheral temperature gradients	Flow distribution
Urine output trends	Renal perfusion
Tissue oxygenation measures	Cellular support

Output

Microcirculatory Recovery Score (MRS-B)

Domain 4

Organ Perfusion Preservation

SCF-DBI Enhancement

The objective of resuscitation is maintenance of organ integrity.

Assessment Domains

Domain	Function
Renal function trends	Kidney preservation
Hepatic function markers	Splanchnic recovery
Neurologic status	Cerebral perfusion
Respiratory function	Pulmonary adaptation
Cardiac performance	Circulatory support

Output

Organ Perfusion Score (OPS-B)

Domain 5

Fluid Toxicity Surveillance

SCF-DBI Enhancement

Excessive fluid administration contributes substantially to morbidity.

Assessment Domains

Domain	Function
Cumulative fluid balance	Over-resuscitation burden
Pulmonary edema indicators	Respiratory compromise
Extremity edema progression	Tissue consequences
Intra-abdominal pressure	Compartment risk
Weight trajectory	Fluid accumulation

Risk States

State	Interpretation
Green	Acceptable fluid exposure
Yellow	Moderate fluid burden
Orange	Significant fluid toxicity
Red	Fluid creep syndrome

Output

Fluid Toxicity Score (FTS)

Domain 6

Metabolic Recovery Surveillance

SCF-DBI Enhancement

Burn shock drives profound metabolic stress.

Assessment Domains

Domain	Function
Lactate normalization	Shock resolution
Base deficit correction	Metabolic recovery
Glucose regulation	Stress adaptation
Acid-base trends	Homeostatic restoration
Nutritional transition readiness	Recovery progression

Output

Metabolic Recovery Score (MRS-M)

Domain 7

RHENOVA Burn Recovery Matrix

SCF-DBI Enhancement

The objective is preservation of life while minimizing secondary injury from both shock and resuscitation.

Recovery Domains

Vascular Recovery

Domain	Function
Endothelial stabilization	Leak control
Microvascular restoration	Perfusion support

Organ Recovery

Domain	Function
Organ preservation	Functional continuity
Metabolic normalization	Systemic resilience

Functional Recovery

Domain	Function
Transition to wound care	Recovery progression
Critical care liberation	Long-term resilience

Output

RHENOVA Burn Recovery Score (RBRS-B)

RHENOVA Integration

R1 — Survival Preservation

Prevent:

Burn shock progression
Refractory hypoperfusion
Multiorgan failure

Output:

Burn Rescue Status

R2 — Recovery Optimization

Restore:

Endothelial competence
Effective perfusion
Organ support

Output:

Recovery Readiness Score

R3 — Regenerative Preservation

Protect:

Glycocalyx integrity
Microvascular architecture
Organ functional reserve

Output:

Microvascular Regeneration Profile

R4 — Functional Restoration

Achieve:

Hemodynamic stability
Liberation from aggressive resuscitation
Transition to definitive burn management

Output:

Burn Restoration Matrix

R5 — Long-Term Resilience

Prevent:

Fluid creep syndrome
Compartment syndromes
Pulmonary complications
Persistent organ dysfunction
Delayed recovery

Output:

Burn Resilience Profile

SCF-DBI Burn Resuscitation Workflow

Step 1

Identify Burn Microvascular Integrity Failure.

Output

Burn Shock Severity Score.

Step 2

Initiate burn resuscitation.

Output

Burn Microvascular Integrity Network Restoration Confirmation.

Step 3

Activate Endothelial Leak Index surveillance.

Output

Endothelial Leak Index.

Step 4

Assess microcirculatory recovery.

Output

Microcirculatory Recovery Score.

Step 5

Evaluate organ perfusion preservation.

Output

Organ Perfusion Score.

Step 6

Monitor fluid toxicity.

Output

Fluid Toxicity Score.

Step 7

Assess metabolic recovery.

Output

Metabolic Recovery Score.

Step 8

Generate the RHENOVA Burn Recovery Matrix.

Output

RHENOVA Burn Recovery Score.

Glossary

Term	Definition
Burn Resuscitation	Critical care management of burn shock through restoration of effective circulation and organ perfusion.
Burn Microvascular Integrity Network (BMIN)	SCF-DBI model describing integrated endothelial, microvascular, and organ recovery systems after major burns.
Burn Microvascular Integrity Failure Syndrome (BMIFS)	SCF-DBI classification describing endothelial leak-driven collapse of adaptive perfusion following burns.
Endothelial Leak Index (ELI)	Primary SCF-DBI framework assessing the degree and trajectory of burn-induced capillary permeability dysfunction.
Burn Shock Severity Score (BSSS)	Assessment of physiologic severity of burn shock and endothelial compromise.
Microcirculatory Recovery Score (MRS-B)	Evaluation of tissue-level perfusion restoration during burn resuscitation.
Organ Perfusion Score (OPS-B)	Assessment of preservation of end-organ blood flow and function.
Fluid Toxicity Score (FTS)	Evaluation of morbidity risk associated with excessive fluid administration.
Metabolic Recovery Score (MRS-M)	Assessment of normalization of burn-associated metabolic derangements.
RHENOVA Burn Recovery Score (RBRS-B)	Integrated measure of endothelial stabilization, organ preservation, and long-term physiologic resilience.

SCF Principle Alignment

SCF Principle	Burn Resuscitation Application
Targeted Action	Restoration of effective perfusion while addressing endothelial dysfunction driving burn shock
Pharmacokinetic Optimization	Preservation of intravascular volume efficiency and microvascular integrity
Metabolic Efficiency	Optimization of tissue oxygen delivery and correction of burn-induced metabolic stress
Resistance Prevention	Prevention of fluid creep, compartment syndromes, pulmonary edema, and multiorgan dysfunction
Safety Profile	Continuous surveillance of endothelial leak, organ perfusion, fluid toxicity, and metabolic recovery

INDEX

SCF-BURN-RESUSCITATION-0001

SCF-DBI-BURN-MICROVASCULAR-INTEGRITY-NETWORK-0001

SCF-DBI-BURN-MICROVASCULAR-INTEGRITY-FAILURE-SYNDROME-0001

SCF-DBI-ENDOTHELIAL-LEAK-INDEX-0001

SCF-DBI-BURN-SHOCK-SEVERITY-SCORE-0001

SCF-DBI-MICROCIRCULATORY-RECOVERY-SCORE-B-0001

SCF-DBI-ORGAN-PERFUSION-SCORE-B-0001

SCF-DBI-FLUID-TOXICITY-SCORE-0001

SCF-DBI-METABOLIC-RECOVERY-SCORE-M-0001

SCF-DBI-RHENOVA-BURN-RECOVERY-MATRIX-0001

SCF-BURN-SHOCK-RESUSCITATION-WORKFLOW-0073

SCF-BURN-RESUSCITATION-MASTER-0001