Pathophysiological response to burns

Abstract

Greater understanding of the pathophysiological response to burns has advanced both the care and outcomes of afflicted patients. Locally, three zones are described by the Jackson burn zone model: the inner coagulation zone (maximal damage), middle dynamic stasis zone (salvageable with first aid and resuscitation) and the, usually, recoverably outer zone of hyperaemia due to increased tissue perfusion. Systemic, multi-organ changes can follow burns affecting greater than 20% total body surface area due to the release of various neurohormonal mediators including cytokines, hormones, catecholamines among others. In the immediate post-burn resuscitation phase, ‘burn shock’ and the resultant end-organ dysfunction negatively affects outcomes. Further, the systemic inflammatory response to large burns is typically hypercatabolic and can last for 2–3 years. This chapter summarizes current understanding of the pathophysiological response to resuscitation and non-resuscitation burns wounds and introduces broad measures aimed at ameliorating its deleterious results.