Patients suffering major burn injury represent a unique population of critically ill patients. Widespread skin and tissue damage causes release of systemic inflammatory mediators that promote endothelial leak, extravascular fluid shifts, and cardiovascular derangement. This phase is characterized by relative intra-vascular hypovolaemia and poor peripheral perfusion. Large volume intravenous fluid resuscitation is generally required. The patients' clinical course is then typically complicated by ongoing inflammation, protein catabolism, and marked haemodynamic perturbation. At all times, drug distribution, metabolism, and elimination are grossly distorted. For hydrophilic agents, changes in volume of distribution and clearance are marked, resulting in potentially sub-optimal drug exposure. In the case of antibiotics, this may then promote treatment failure, or the development of bacterial drug resistance. As such, empirical dose selection and pharmaceutical development must consider these features, with the application of strategies that attempt to counter the unique pharmacokinetic changes encountered in this setting.

遭受严重烧伤的患者代表了危重患者的独特群体。广泛的皮肤和组织损伤会导致全身性炎症介质释放，从而促进内皮泄漏，血管外液移位和心血管疾病。该阶段的特征是相对的血管内低血容量和不良的外周血流灌注。通常需要大剂量的静脉液体复苏。然后，患者的临床过程通常会由于持续的炎症，蛋白质分解代谢和明显的血液动力学扰动而变得复杂。在任何时候，药物的分配，新陈代谢和消除都会严重扭曲。对于亲水剂，标记了分布和清除体积的变化，导致潜在的次优药物暴露。如果是抗生素，这可能会导致治疗失败或细菌耐药性的发展。因此，经验剂量的选择和药物开发必须考虑这些特征，并尝试应用应对这种情况下所遇到的独特药代动力学变化的策略。