ABSTRACT
The survival rate of patients suffering from large total body surface area (TBSA) burns has improved significantly during the last 30 years. Much of this survival benefit is due to advances in fluid management. Prior to the 1940s, most patients with large TBSA burns died from hypovolemic shock and renal failure. It later became apparent that burn patients develop intravascular hypovolemia in association with generalized interstitial edema. Underhill (1) was one of the first to develop the concept of burn shock through his study of victims from the Rialto Theater fire in 1921. Cope and Moore (2) confirmed and extended these observations through their study of burn patients in the 1940s. They hypothesized that the transfer of fluid from the intravascular compartment to the interstitium was responsible for the development of the edematous state.
