Objective The authors provide an update on a multidisciplinary approac
h to the treatment of severely burned patients. A review of studies an
d clinical trials from the past to the present include fluid resuscita
tion, sepsis, immune function, hypermetabolism, early excision, wound
healing, scar formation, and inhalation injury. Summary Background Dat
a Advances in treating initial burn shock, infection control, early wo
und closure, and modulation of the hypermetabolic response have decrea
sed morbidity and mortality in the last two decades. Specialized burn
care centers, using a multidisciplinary approach, not only successfull
y treat large burns and their complications, but provide the necessary
rehabilitation and psychological support required for readjustment ba
ck into society. Conclusions Thermal injury results in a number of phy
siologic alterations that can be minimized by adequate fluid resuscita
tion to maintain tissue perfusion, early excision of burn wounds, and
rapid wound coverage. These measures, in combination with antibiotic c
overage and nutritional support in the form of early enteral tube feed
ings, will decrease the hypermetabolic response and the incidence of s
epsis that can lead to hemodynamic instability and organ failure. Ongo
ing clinical trials using anabolic agents (e.g., recombinant human gro
wth hormone) and pharmacologic agents that modulate inflammatory and e
ndocrine mediators(e.g., ibuprofen and propranolol) show promise in th
e treatment of severe burn injuries.