Long-term propranolol use in severely burned pediatric patients

A randomized controlled study

David Herndon, Noe A. Rodriguez, Eva C. Diaz, Sachin Hegde, Kristofer Jennings, Ronald P. Mlcak, Jaipreet S. Suri, Jong Lee, Felicia N. Williams, Walter Meyer, Oscar Suman, Robert E. Barrow, Marc G. Jeschke, Celeste Finnerty

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)402-411
Number of pages10
JournalAnnals of Surgery
Volume256
Issue number3
DOIs
StatePublished - Sep 2012

Fingerprint

Propranolol
Pediatrics
Burns
Energy Metabolism
Body Composition
Body Surface Area
Wounds and Injuries
Hot Temperature
Heart Rate
Fats
Regression Analysis
Safety
Bone and Bones
Therapeutics

Keywords

  • beta blockade
  • hypermetabolism
  • lean body mass
  • propranolol

ASJC Scopus subject areas

  • Surgery

Cite this

Long-term propranolol use in severely burned pediatric patients : A randomized controlled study. / Herndon, David; Rodriguez, Noe A.; Diaz, Eva C.; Hegde, Sachin; Jennings, Kristofer; Mlcak, Ronald P.; Suri, Jaipreet S.; Lee, Jong; Williams, Felicia N.; Meyer, Walter; Suman, Oscar; Barrow, Robert E.; Jeschke, Marc G.; Finnerty, Celeste.

In: Annals of Surgery, Vol. 256, No. 3, 09.2012, p. 402-411.

Research output: Contribution to journalArticle

Herndon, D, Rodriguez, NA, Diaz, EC, Hegde, S, Jennings, K, Mlcak, RP, Suri, JS, Lee, J, Williams, FN, Meyer, W, Suman, O, Barrow, RE, Jeschke, MG & Finnerty, C 2012, 'Long-term propranolol use in severely burned pediatric patients: A randomized controlled study', Annals of Surgery, vol. 256, no. 3, pp. 402-411. https://doi.org/10.1097/SLA.0b013e318265427e
Herndon, David ; Rodriguez, Noe A. ; Diaz, Eva C. ; Hegde, Sachin ; Jennings, Kristofer ; Mlcak, Ronald P. ; Suri, Jaipreet S. ; Lee, Jong ; Williams, Felicia N. ; Meyer, Walter ; Suman, Oscar ; Barrow, Robert E. ; Jeschke, Marc G. ; Finnerty, Celeste. / Long-term propranolol use in severely burned pediatric patients : A randomized controlled study. In: Annals of Surgery. 2012 ; Vol. 256, No. 3. pp. 402-411.
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AU - Diaz, Eva C.

AU - Hegde, Sachin

AU - Jennings, Kristofer

AU - Mlcak, Ronald P.

AU - Suri, Jaipreet S.

AU - Lee, Jong

AU - Williams, Felicia N.

AU - Meyer, Walter

AU - Suman, Oscar

AU - Barrow, Robert E.

AU - Jeschke, Marc G.

AU - Finnerty, Celeste

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N2 - 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.

AB - 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.

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