Progress in burns research: a review of advances in burn pathophysiology

Severe burns trigger a wide range of responses in the victim. Initial vascular changes are followed by hypermetabolic, inflammatory and immunologic changes. The prolonged hypermetabolic response is associated with an elevated resting rate of energy consumption, tissue wasting and altered substrate kinetics. There is increased blood glucose though insulin levels are above normal. The cortisol level is raised and, together with catecholamine, drives the metabolic response. The immune system is typically weakened. There is elevation in blood levels of a wide range of cytokines from activated cells. These agents drive a prolonged inflammatory response which can lead to tissue damage and multiple organ failure. Dynamic fluid resuscitation regimens have cut down mortality from shock in the early post-burn period. However, unbalanced activity of pro- and anti-inflammatory cytokines can leave patients in an immuno-suppressed state that affects outcomes. So far, many treatments, such as propranolol, a cardio-protector, and anabolic agents, such as oxandrolone and growth hormone, have been tried with mixed results. This review focuses on research that elucidated burn pathophysiology. Some clinical areas in which treatment centred on correcting altered physiology were also included. We have highlighted both the challenges and significant findings. Finally, this paper draws attention to the gaps between progress in basic research and clinical application and suggests areas where further research and funding could be focused.