The first 5 hours after burn injury

Recent research has given a new insight in the mechanism of burn shock. Tightening layers of the vascular system are the glycocalyx and the basal membrane layers as well as intercellular junctions. These layers are the basis of different effects of fluids, like the consensual effect of colloids and the starling effect, which had to be revised under the findings of glycocalyx and of different types of capillaries. Immediately after the injury the renin angiotensin aldosterone system is effective. Hyperresuscitation in this very early phase leads to the release of natriuretic peptide, causing degradation of the glycocalyx and setting free hyaluronan fragments such causing capillary leak. Capillary leak leads to burn shock. Different partially controversial finding in recent literature on burn shock can be explained by the loss of the glycocalyx and a practical approach to burn shock treatment in the initial phase according to these findings can be developed and will be demonstrated as well as ways to influence the restitution of the glycocalyx.