Modern concepts of the pathogenesis of burn shock in children

Abstract

This review presents contemporary concepts of the pathogenesis of burn shock (BS) in children from the perspective
of integrative pathophysiology. Traditional concepts of burn shock pathogenesis are analyzed, including fluid
loss, hypovolemia, macrocirculatory, microcirculatory, neurohumoral, and metabolic disturbances, and the need
for their modern refinement is emphasized in light of clinical phenomena characteristic of the pediatric population,
including the dissociation between apparent macrocirculatory stabilization and persistent tissue hypoxia.
Particular attention is given to endothelial dysfunction and glycocalyx degradation as early and pathogenetically
pivotal events in pediatric burn shock, leading to increased vascular permeability, interstitial edema, and
microcirculatory impairment. Disturbances of hemodynamic coherence, systemic inflammatory response, and
burn-induced coagulopathy are considered as interconnected mechanisms that aggravate tissue hypoperfusion.
Cellular and subcellular alterations, including mitochondrial dysfunction and energy deficit, are analyzed as
key contributors to the development of functional refractoriness to standard fluid resuscitation. Metabolic and
neuroendocrine changes sustaining hypercatabolism and limiting adaptive reserves in children are also addressed.
An integrative pathophysiological model of burn shock in children is proposed, conceptualizing shock as a loss
of coordinated regulation across vascular, microcirculatory, cellular, and metabolic levels. This multidimensional framework extends beyond the traditional hypovolemic paradigm and provides a basis for refining diagnostic
approaches and developing pathogenetically grounded therapeutic strategies in pediatric critical care.
Keywords: burn shock; children; endothelial dysfunction; glycocalyx; microcirculation; systemic inflammatory response;
coagulopathy; mitochondrial dysfunction; hypermetabolism; multiple organ dysfunction.