Application of beta-blockers in burn management
Severe burn injuries cause chronic inflammation, which produces a subsequent hypermetabolic response that starts immediately and persists for at least 3 years. The hypermetabolic state, which is thought to be due to postburn elevations of endogenous cat-echolamines and cortisol, is associated with a number of harmful physiologic derangements including immunosuppression, impaired wound healing, muscle catabolism, and hepatic dysfunction. Beta-blockers have become first line agents for reducing these adverse effects of hypermetabolism in severe burns. This review discusses the underlying pharmacological mechanisms demonstrated by clinical studies evaluating the safety and efficacy of beta-blockers in the management of burn injuries. A litera-ture search was performed using the PubMed database to identify articles on beta-blockers and burn management. The review yielded 33 relevant results consisting of randomized controlled trials, original research articles, and meta-analyses in pediatric and adult burn patients. Propranolol administration reduced insulin resistance, lipolysis, proteolysis, cardiac work, and bone loss resulting from burn-associated hypermetabolism. Propranolol also effectively reduced myocardial stress, resting energy expend-iture, and central deposition of fat. Recent studies have begun to evaluate incorporation of anabolic agents and rehabilitative exercise therapy. However, at this time propranolol continues to be the most effective therapy for reducing the hypermetabolic response and other morbidities resulting from burn injuries.
Jonathan Kopel, PhD, is an MD/PhD student, Gregory L. Brower, MD, is associate professor of medical education, and Grant Sorensen, MD, is a general surgery resident at Texas Tech University Health Sciences Center. John Griswold, MD, is professor and medical director of the Timothy J. Harnar Burn Centerin Lubbock, Texas. Dr. Griswold is a consultant with Medline and an advisor for Exsurco. All of the relevant financial relationships listed for this individual have been mitigated. The planner and other authors for this educational activity have no relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.
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Credit eligibility for this article is set to expire on January 1, 2024.
After completing the article, the learner should be able to:
- describe the importance of hypermetabolism in the pathogenesis of burn injuries
- describe the benefits of beta-blockers in burn injuries for preventing long-term complications
- describe the effects of beta-blockers for pediatric burn patients for improving growth and metabolism after burn injuries
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