Inflammation and sepsis: past, present, and the future.

A critical burn injury is a unique trauma that often is accompanied by significant metabolic disturbances as well as perturbation of innate and adaptive immunity. Human skin is not only a barrier against environmental insults and against colonization of pathogenic microbes but, more importantly, it is an immune organ with significant surveillance and thermoregulatory functions. Therefore, it is hardly surprising that loss of large portions of skin as the result of burns results in impaired immunity, metabolic compromises, fluid shifts, and heat loss. Through improvements in resuscitation, critical care, nutritional support, and early closure of the burn wound during the past two decades, our ability to care for burn patients has resulted in a marked reduction in morbidity and mortality. However, nosocomial wound or pulmonary infections, especially in patients requiring ventilator assistance, remain a major problem.