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Severe burn injury results in a systemic inflammatory response that leads to increased capillary permeability and fluid leak into the interstitium. This global systemic capillary leak can be attributed, at least in part, to inflammatory mediators produced as a result of cellular injury. Plasma exchange has been used in the management of a number of illnesses with a significant inflammatory component, and, therefore, may have a role in the early management of burn injury. The purpose of this study was to review our institutional experience using plasma exchange in the management of severe burn injury. We performed a retrospective review of all patients receiving plasma exchange at our burn center between 2001 and 2005. Data collected included the following: burn size, presence of inhalation injury, resuscitation fluid received, urine output, lactate levels, base deficit levels, and hematocrit before and after the exchange procedure. A total of 37 patients underwent plasma exchange during the 5-year study period and seven patients underwent two plasma exchange treatments. Average TBSA burned was 48.6% (range 18-82) and 73% of patients sustained an inhalation injury. After plasma exchange, hourly fluid volume received significantly decreased (P < .05) and base deficit, lactate, and hematocrit levels significantly improved. Plasma exchange in the early resuscitation period was associated with decreased fluid administration, as well as increased urine output in the period during and immediately after the procedure. These data suggest that plasma exchange may provide a useful tool in the management of severe burn injury.