Table 3.

The 3 H’s of burn sepsis.

Organ System	Main Issue	Clinical Signs	Additional Parameter
Respiratory	Hypoxia (impaired gas exchange)	tachypnoea, dyspnoea, desaturation, increasing O2-flow/FiO2	decreasing PO2/FiO2-ratio, radiologic signs of pneumonia?
Cardiovascular	Hypovolaemia	increasing tachycardia, decreasing systolic pressure, swinging arterial pressure curve	volumetric status: increasing respiratory variability (inferior vena cava), decreasing stroke volume/ventricular filling; decreasing systemic vascular resistance
Body Temperature	Hypo-/ Hyperthermia	<36.5 °C >39.0 °C	routine microbiologic screening: causative agents?
≥2 criteria positive without other apparent cause = sepsis screening positive
-> measure blood lactate
≤2 mmol/L: increasing BurnSOFA score? -> consider sepsis and search for possible source and causative agents, -> check additional parameters and inflammatory biomarkers (PCT, IL-6) -> start sepsis treatment if additional parameters indicate sepsis
≥2 mmol/L (increasing lactate level without other detectable cause): initiate sepsis bundle without further delay! -> start antimicrobial treatment within 45 min -> begin with antibiotic bolus to gain therapeutic levels -> discontinue antibiotics if non-septic causes show higher probability