Modulation of the hypermetabolic response after burn injury

The hypermetabolic response to severe burn injury is a double-edged sword. Initially after burn injury, dramatic increases in energy flux are necessary to maintain thermal homeostasis, overcome burn shock, and permit survival. However, these same responses, as a normal burn recovery progresses (increased cardiac work, elevated resting energy expenditure, and loss of lean body mass with subsequent decreased muscle strength) result from postburn hypermetabolism. Additionally, elements of the hypermetabolic response remain elevated above normal for up to 3 years. This chapter reviews the metabolic alterations that occur after severe burn injury as well as various pharmacologic therapies that are being used and/or investigated for use to attenuate the hypermetabolic response.