1. Military Hospital "Queen Astrid"
   Depts of Burn Care and Hyperbaric Oxygen Therapy
   Brussels - BELGIUM
2. BerufsGenossenschafts Unfallklinikum Murnau
   Dept of Intensive Care, Burn Care and Hyperbaric Medicine
   Murnau - GERMANY
3. Rigshospitalet
   Dept of Anaesthesia and National Burn Unit
   Kopenhagen - DENMARK
4. Karolinska Institut
   Burn Care Unit and Dept of Anesthesia
   Stockholm - SWEDEN
5. Allgemeines Krankenhaus Wien
   Dept of Anesthesia and Burn Center
   Vienna - AUSTRIA

To evaluate possible effect of HBO on the conversion of 2^nd degree burn wounds to 3^rd degree burn wounds during the 1^st 24 hours after the burn.

To evaluate possible effect of HBO on oedema formation after the burn, as evaluated during the first three days.

Evaluation of effect of HBO on other parameters:

• total weight loss during first 3 days of hospitalisation
• fluid resuscitation requirements (total volume infused during 1^st week)
• duration of ICU stay
• need for and duration of intubation
• incidence of infection
• incidence of general complications
• total epithelialisation time (need for daily wound dressings)

• 20%-80% TBSA burned
• at least 50% of TBSA = 2^nd degree burn
• no restriction as to site burned
• age group: 18 to 70 years
• concomitant pathology: diseases to be excluded (cardiac insufficiency, renal insufficiency, pulmonary insufficiency)
• stratification to be made for

• age groups (18-45, 45-70)
• cause of burn wound (flame, surface, water)
• inhalation injury yes/no
• site burned: face/neck, chest, hands

• evaluation of TBSA burned (9% rule)
• evaluation of TBSA 2^nd degree burn: clinical evaluation, based upon 5 parameters

Parameter	3	2	1	Remarks
color	white, black	pink	red
sensitivity	no		yes
capillary refill	none	> 10 secs	< 10 sec
blistering	yes		no
humidity		humid	dry
Sum				If > 10 = 3rd degree If < 6 = 1st degree

• escharotomies as necessary
• weighing
• parameters, incl. CVP
• fluid resuscitation: 1^st 24hrs: 3ml/kg/% of Hartmann® solution, first 50% in 8hrs – on day 2 and further: on guidance of diuresis (minimal 0.5ml/min)
• no systematic ATB given
• cardiac support: (dopamine), dobutamine, levorenine, adrenaline
• wound dressing: flammazine®, daily dressing changes in sterile bath (hibitane® in water)

• after randomisation:
• HBO : 2.0 ATA 3x25minutes, 2x /day for 3 days – 1^st HBO < 12hrs after burn wound infliction, > 8 hrs interval between HBO sessions
• Non-HBO: standard care
• re-evaluation daily (% TBSA 3^rd, 2^nd degree), scoring system, weight, CVP

• hands: after < 1 week if deep 2^nd degree or 3^rd degree
• rest of body: after 1-2 weeks depending on stability of patient
• if TBSA burned is high: first excision of 3^rd degree zones, coverage with homografts (cadaver skin)
• if mainly deep 2^nd degree and moderate TBSA burned: autograft coverage
• no use of artificial skin or keratocyte cultures (may be used if TBSA > 80% = exclusion from study)

• superficial or systemic infection with other than Staphylococcus epidermidis during first week
• ARDS (defined as: X-ray diffuse bilateral interstitial and alveolar infiltration, PaO2 < 60mmHg despite 10lpm 100% O2 in face mask) , renal failure (defined as: uremia > 100mg/dl, serum creatinin > 8 mg/dl) during first week

• % TBSA 2^nd and 3^rd degree burn on day 1 (intake)
• % TBSA 2^nd and 3^rd degree burn on day 2
• % TBSA 2^nd and 3^rd degree burn on day 3
• % TBSA 2^nd and 3^rd degree burn on day 4
• % TBSA grafted, as compared to assessment of % TBSA deep 2^nd and 3^rd degree burn on day 4
• weight gain evolution

• total fluid volume infused during 1^st week
• duration of ICU stay
• need for and duration of intubation

• number of excision/grafting procedures performed
• time to complete (> 95%) epithelialisation

• incidence of infection
• incidence of general complications (ARDS, renal failure)