Although the outcome of burn patients has been improved, many aspects of management of severe burn patients remain controversial. Here we focus on the management of hypermetabolism and the resuscitation of respiratory function. Currently, the fluid resuscitation method shifts from insufficient fluid regimen to excessive fluid loading. The benefit of colloid infusion and restrictive blood transfusion need to be authenticated by further clinical trial, and the best form of fluid resuscitation has yet to be identified. The respiratory management of burn patients had been improved. Early tracheostomy, ventilation with low tidal volume and bronchoalveolar toilet are recommended. Many potential beneficial treatment strategies have been identified by recent research in the metabolic response to burn injury. Although immunomodulation therapy is promising, most of them are not clinical viable,and further clinical research is warranted.