BURN-ASV Trial: adaptive Support Ventilation in Severe Burn Injury

Severe burn injury is frequently complicated by respiratory failure resulting frominhalation injury, systemic inflammation, pulmonary edema, acute respiratory distresssyndrome (ARDS), and prolonged critical illness. Mechanical ventilation is often requiredfor extended periods and is associated with substantial morbidity, includingventilator‐associated pneumonia, ventilator‐induced lung injury, prolonged sedationexposure, and increased intensive care unit (ICU) length of stay.Modern military conflicts have introduced new mechanisms of burn injury, includingdrone‐delivered munitions and thermobaric explosive devices. These injuries are oftencharacterized by a combination of thermal injury, blast overpressure, airway damage,inhalation injury, and severe pulmonary dysfunction. As a result, optimization ofventilatory support has become an important component of burn critical care.Adaptive Support Ventilation (ASV) is a closed‐loop mode of mechanical ventilation thatautomatically adjusts respiratory rate, tidal volume, inspiratory pressure, and minuteventilation according to patient respiratory mechanics and predicted physiologicrequirements. Previous studies in mixed ICU populations have suggested that ASV mayimprove patient‐ventilator synchrony, reduce work of breathing, facilitate weaning, anddecrease the duration of mechanical ventilation. However, evidence regarding its use insevere burn patients remains limited.The BURN‐ASV Trial is a prospective randomized controlled study designed to compareAdaptive Support Ventilation with conventional lung‐protective mechanical ventilation incritically ill adult burn patients requiring invasive mechanical ventilation.Participants will be randomized in a 1:1 ratio to receive either ASV or conventionalventilation according to institutional standards of care. Randomization will bestratified by burn severity, inhalation injury, thermobaric injury, and the presence ofARDS.The primary objective is to determine whether ASV increases ventilator‐free days duringthe first 28 days following randomization. Secondary objectives include evaluation ofmechanical ventilation duration, ventilator‐associated complications, oxygenation,ventilator mechanics, sedation and opioid requirements, ICU and hospital length of stay,and mortality.The results of this study are expected to provide evidence regarding the effectivenessand safety of automated ventilation strategies in patients with severe burn injuries andmay contribute to future recommendations for respiratory support in both civilian andmilitary burn intensive care settings.