After several decades studying the pathophysiology of patients with large burned areas is clearly critical to the survival of these patients a fast and effective fluid therapy. However, since in 1968 Baxter and Shires developed the Parkland formula, little progress has been made in this field.The implementation of the new guided therapies by objectives and the alert issued by the European Medicines Agency on the use of starches in these patients led a group of researchers from Vall d'Hebron Research Institute (VHIR), the http://www.vhebron.net/en/anestesiologia-i-reanimacio" Department of Anaesthesiology and Resuscitation and the http://www.vhebron.net/en/plastica/cremats" Plastic Surgery and Burns Services of the University Hospital Vall d'Hebron, to conduct a review of scientific articles published from 2000 to 2014.The main objective of this study is to review the initial resuscitation fluid therapy for severe burn trying to answer the following questions: What is the best way to determine how much fluid do these patients need? and, what are the optimal fluids for this resuscitation?This study has been published in the https://academic.oup.com/bja/article-lookup/doi/10.1093/bja/aew266" British Journal of Anaesthesia and has been considered one of the https://academic.oup.com/bja/pages/best_of_2016" best articles of 2016.The volume of fluid required in the initial phase of treatmentOne of the priorities in treating burn patients is to ensure that they remain hemodynamically stable. "The major burns patient is a traumatic patient who requires a much higher initial fluid load in the resuscitation than the load we would administer in other patients. Among the pathophysiological changes suffered by these patients there are hypovolemic shock and altered capillary permeability, so it is essential to perform an adequate fluid therapy so as to maintain organ perfusion and not aggravate the injury, "explains Dr. Patricia Guilabert Sanz researcher of the http://en.vhir.org/portal1/grup-equip.asp?s=recerca&contentid=187124 Reconstructive Surgery of the Locomotor System Group of the Vall d'Hebron Research Institute and one of the study's authors.When the fluid therapy is not optimal, the depth of the burn increases and the shock period is longer, increasing morbidity and mortality.According to the results of the studies analysed, the amount of fluid supplied in the first 24 hours should be somewhat higher than estimated by the Parkland formula, although the total amount administered is maintained."The initial resuscitation should ideally be guided by objectives, although in the burned patient these objectives are yet to be defined," she says.What fluids to be used?When we speak of fluid resuscitation of severely burned, a guided treatment of transpulmonary thermodilution methods is recommended since they are less invasive than the PAC (pulmonary artery catheter) and have been validated in burned. Some studies have shown an improvement in cardiac index, ScvO2, oxygen supply and MODS (Multiorgan Dysfunction Score) when the fluid was based on TTD (transpulmonary thermodilution) taking as final objectives ITBV (intrathoracic blood volume) and EVLW (extravascular lung water). However, the optimal parameters are undefined.The fluid used in the initial resuscitation phase should be a balanced crystalloid.Colloids seem inadequate in the early hours due to the increased capillary permeability of the patient. However, there is insufficient scientific evidence at the moment to justify the alert for starches in burned patients, explains Dr. Guilabert.Ringer's acetate appears to protect the electrolyte balance in large replacements and is a candidate for crystalloid of choice for initial resuscitation in burn patients.Gelatins have not demonstrated superiority over crystalloids in its expandability and their safety, it is still uncertain.Hypertonic solutions, albumin and plasma, have been associated with a reduced requirement for initial resuscitation fluids, as well as a lower intraabdominal pressure and incidence of compartment syndrome. Although these solutions could be interesting, it takes more evidence to support their use.In short, more studies to generate quality scientific evidence on initial resuscitation of major burn patient to define the most appropriate fluid therapy in this group of patients are needed.Similarly, there is a lack of evidence on the objectives for TTD, the difference between the initial resuscitation with Ringer lactate vs Ringer acetate, the most appropriate time to initiate therapy with colloids and the benefits and risks of the administration of different natural and synthetic colloids in major burn patient.