Reversal of Catabolism by Beta-Blockade after Severe Burns (original) (raw)
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Effects of Propranolol and Exercise Training in Children with Severe Burns
The Journal of Pediatrics, 2013
Study design-Children aged 7-18 years (n=58) with burns covering ≥30% of the total body surface area (TBSA) were enrolled in this randomized trial during their acute hospital admission. Twenty-seven patients were randomized to receive propranolol, whilst 31 served as untreated controls. Both groups participated in 12 weeks of in-hospital resistance and aerobic exercise training. Muscle strength, lean body mass, and peak aerobic capacity (VO 2 peak) were measured before and after exercise training. Paired and unpaired Student T-tests were used for within and between group comparisons, and Chi-squared tests for nominal data.
Annals of …, 1988
Effect of Propranolol Administration on Hemodynamic and Metabolic Responses of Burned Pediatrc Patients DAVID N. HERNDON, MD, ROBERT E. BARROW, PH.D., THOMAS C. RUTAN, MSN, PAUL MINIFEE, MD, FAROUK JAHOOR, PH.D., and ROBERT R. WOLFE, PH.D. ...
Propranolol attenuates factors affecting hypermetabolism in pediatric burn patients
Critical Care, 2007
Hydrogen sulfide is produced endogenously by a variety of enzymes involved in cysteine metabolism. Clinical data indicate that endogenous levels of hydrogen sulfide are diminished in various forms of cardiovascular diseases. The aim of the current study was to investigate the effects of hydrogen sulfide supplementation on cardiac function during reperfusion in a clinically relevant experimental model of cardiopulmonary bypass. Twelve anesthetized dogs underwent hypothermic cardiopulmonary bypass. After 60 minutes of hypothermic cardiac arrest, reperfusion was started after application of either saline vehicle (control, n = 6), or the sodium sulfide infusion (1 mg/kg/hour, n = 6). Biventricular hemodynamic variables were measured by combined pressure-volume-conductance catheters. Coronary and pulmonary blood flow, vasodilator responses to acetylcholine and sodiumnitroprusside and pulmonary function were also determined. Administration of sodium sulfide led to a significantly better recovery of left and right ventricular systolic function (P < 0.05) after 60 minutes of reperfusion. Coronary blood flow was also significantly higher in the sodium sulfide-treated group (P < 0.05). Sodium sulfide treatment improved coronary blood flow, and preserved the acetylcholine-induced increases in coronary and pulmonary blood (P < 0.05). Myocardial ATP levels were markedly improved in the sulfide-treated group. Thus, supplementation of sulfide improves the recovery of myocardial and endothelial function and energetic status after hypothermic cardiac arrest during cardiopulmonary bypass. These beneficial effects occurred without any detectable adverse hemodynamic or cardiovascular effects of sulfide at the dose used in the current study.
Journal of the College of Physicians and Surgeons Pakistan, 2020
Objective: To compare the mean duration of wound healing and attenuation of muscle wasting in adult burn patients treated with propranolol and control group. Study Design: A randomised controlled trial. Place and Duration of Study: Allied Burn and Reconstructive Surgery Center, Faisalabad from March to August 2018. Methodology: Seventy adult burn patients with 20-40% burn of the total body surface area (TBSA) were included in the study and divided into two groups; propranolol group and control group. Propranolol was administered at dose of 0.5-3 mg/Kg body weight per day along with standard burn care treatment during the entire period of treatment. Results: Faster healing of the superficial burns was noticed in the patients of propranolol group. In superficial burns lesser time was needed for adequate healing; 13.20 ±1.90 days versus 20.34 ±2.32 days (p <0.001). At the same time, lesser time was required for deep burn patients treated with propranolol to be ready for skin grafting; 23.87 ±2.36 versus 33.64 ±3.15 days; p <0.001) comparing control group. Mean mid-arm circumference was 27.57 ±1.62 cm in study group and 24.46 ±1.77 cm in control group (p<0.0001) which was statistically significant. This result showed that hypermetabolic response of burn in terms of muscle wasting was clearly modulated by betablocker therapy. Conclusion: Propranolol administration in adult burn patients appears to be beneficial in reducing morbidity, mortality and hospital stay by enhancing earlier wound healing and attenuating the catabolic muscle wasting in response to stress caused by burn.
Long-Term Propranolol Use in Severely Burned Pediatric Patients
Annals of Surgery, 2012
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 singlecenter controlled study in pediatric patients with large burns. Summary Background Data-Severe burns trigger a hypermetabolic response that persists for up to 2 years after burn. Propranolol given for 1 month post burn blunts this response. Whether propranolol administration for 1 year after injury provides a continued benefit is currently unclear.
Propranolol decreases cardiac work in a dose-dependent manner in severely burned children
Surgery, 2011
Background. Severe burn is followed by profound cardiac stress. Propranolol, a nonselective b 1, b 2-receptor antagonist, decreases cardiac stress, but little is known about the dose necessary to cause optimal effect. Thus, the aim of this study was to determine in a large, prospective, randomized, controlled trial the dose of propranolol that would decrease heart rate $15% of admission heart rate and improve cardiac function. Four-hundred six patients with burns >30% total body surface area were enrolled and randomized to receive standard care (controls; n = 235) or standard care plus propranolol (n = 171). Methods. Dose-response and drug kinetics of propranolol were performed. Heart rate and mean arterial pressure (MAP) were measured continuously. Cardiac output (CO), cardiac index, stroke volume, rate-pressure product, and cardiac work (CW) were determined at regular intervals. Statistical analysis was performed using analysis of variance with Tukey and Bonferroni corrections and the Student t test when applicable. Significance was accepted at P < .05. Results. Propranolol given initially at 1 mg/kg per day decreased heart rate by 15% compared with control patients, but was increased to 4 mg/kg per day within the first 10 days to sustain treatment benefits (P < .05). Propranolol decreased CO, rate-pressure product, and CW without deleterious effects on MAP. The effective plasma drug concentrations were achieved in 30 minutes, and the half-life was 4 hours. Conclusion. The data suggest that propranolol is an efficacious modulator of the postburn cardiac response when given at a dose of 4 mg/kg per day, and decreases and sustains heart rate 15% below admission heart rate.
Hyperglycemia exacerbates muscle protein catabolism in burn-injured patients
Critical Care Medicine, 2002
The purpose of this study was to assess if hyperglycemia influences energy expenditure or the extent of muscle protein catabolism in severely burned adults. Design: Retrospective study. Setting: Burn intensive care unit at a university hospital. Patients: Adults with burns on >40% of their body surface area. Interventions: Simultaneous measurement of indirect calorimetry and leg net balance of phenylalanine (as an index of muscle protein catabolism). Patients were stratified by plasma glucose values at the time of metabolic measurements (i.e., normal, glucose at <130 mg/dL; mild hyperglycemia, glucose at 130-200 mg/dL; severe hyperglycemia, glucose at >200 mg/dL). Measurements and Main Results: Normal (n ؍ 9; plasma glucose, 109 ؎ 13 mg/dL [mean ؎ SD]), mildly hyperglycemic (n ؍ 13l plasma glucose, 156 ؎ 17 mg/dL), and severely hyperglycemic subjects (n ؍ 7, glucose 231 ؎ 32 mg/dL) were similar in age, body weight, extent of burn area, and daily caloric intake. Severe hyperglycemia was associated with significantly higher arterial concentrations of phenylalanine (normal, 0.079 ؎ 0.027 mol/L; severe hyperglycemia, 0.116 ؎ 0.028; p < .05) and a significantly greater net efflux of phenylalanine from the leg (normal, ؊0.067 ؎ 0.072 mol•min ؊1 •100 mL ؊1 leg volume; severe hyperglycemia, ؊0.151 ؎ 0.080 mol•min ؊1 •100 mL ؊1 leg volume; p < .05). Resting energy expenditure and respiratory quotient were similar between patient groups. Conclusions: These findings demonstrate an association between hyperglycemia and an increased rate of muscle protein catabolism in severely burned patients. This suggests a possible link between resistance of muscle to the action of insulin for both glucose clearance and muscle protein catabolism.
Annals of Surgery, 2016
Background-The hypercatabolic response in severely burned pediatric patients is associated with increased production of catecholamines and corticosteroids, decreased formation of testosterone, and reduced strength alongside growth arrest for up to 2 years post injury. We have previously shown that, in the pediatric burned population, the administration of the testosterone analog oxandrolone improves lean body mass accretion and bone mineral content and that the administration of the β1, β2 adrenoreceptor antagonist propranolol decreases cardiac work and resting energy expenditure while increasing peripheral lean mass. Here, we determined whether the combined administration of oxandrolone and propranolol has added benefit. Methods-In this prospective, randomized study of 612 burned children (52 ± 1% of total body surface area burned, ages 0.5-14 years [males]; ages 0.5-12 years [females]), we compared controls to the individual administration of these drugs, and the combined administration of