Long-Term Propranolol Use in Severely Burned Pediatric... : Annals of Surgery (original) (raw)

Papers of the 132nd ASA Annual Meeting

A Randomized Controlled Study

Herndon, David N. MD, FACS*,†; Rodriguez, Noe A. MD*,†; Diaz, Eva C. MD*,†; Hegde, Sachin MD*,†; Jennings, Kristofer PhD‡; Mlcak, Ronald P. PhD*; Suri, Jaipreet S. BS, BBA§; Lee, Jong O. MD*,†; Williams, Felicia N. MD*,†; Meyer, Walter MD*,‖; Suman, Oscar E. PhD*,†; Barrow, Robert E. PhD*; Jeschke, Marc G. MD, PhD¶; Finnerty, Celeste C. PhD*,†,#,**

From the *Shriners Hospitals for Children—Galveston, Texas

†Department of Surgery

‡Department of Preventative Medicine and Community Health

§School of Medicine

‖Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas

¶Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre and Division of Plastic Surgery, University of Toronto, Ontario, Canada

#Institute for Translational Sciences

**Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Texas.

Reprints: David N. Herndon, MD, FACS, Shriners Hospitals for Children—Galveston, 815 Market St, Galveston, TX 77550. E-mail: [email protected].

Disclosure: This study was supported by grants from the National Institute for Disabilities and Rehabilitation Research (H133A070026 and H133A70019), the National Institutes of Health (P50-GM60338, R01-HD049471, R01-GM56687-11S1, and T32-GM8256), and Shriners Hospitals for Children (84080, 84309, 8660, 9145, and 8760). Dr Finnerty is an ITS Career Development Scholar supported, in part, by NIH KL2RR029875 and NIH UL1RR029876. This study is registered at clinicaltrials.gov: NCT00675714.

Drs. Herndon and Finnerty contributed equally to this work.

Objective:

To determine the safety and efficacy of propranolol given for 1 year on cardiac function, resting energy expenditure, and body composition in a prospective, randomized, single-center, controlled study in pediatric patients with large burns.

Background:

Severe burns trigger a hypermetabolic response that persists for up to 2 years postburn. Propranolol given for 1 month postburn blunts this response. Whether propranolol administration for 1 year after injury provides a continued benefit is currently unclear.

Methods:

One-hundred seventy-nine pediatric patients with more than 30% total body surface area burns were randomized to control (n = 89) or 4 mg/kg/d propranolol (n = 90) for 12 months postburn. Changes in resting energy expenditure, cardiac function, and body composition were measured acutely at 3, 6, 9, and 12 months postburn. Statistical analyses included techniques that adjusted for non-normality, repeated-measures, and regression analyses. P < 0.05 was considered significant.

Results:

Long-term propranolol treatment significantly reduced the percentage of the predicted heart rate and percentage of the predicted resting energy expenditure, decreased accumulation of central mass and central fat, prevented bone loss, and improved lean body mass accretion. There were very few adverse effects from the dose of propranolol used.

Conclusions:

Propranolol treatment for 12 months after thermal injury, ameliorates the hyperdynamic, hypermetabolic, hypercatabolic, and osteopenic responses in pediatric patients. This study is registered at clinicaltrials.gov: NCT00675714.