Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults

Arham Ali, David Herndon, Ashish Mamachen, Samir Hasan, Clark R. Andersen, Ro Jon Grogans, Jordan L. Brewer, Jong Lee, Jamie Heffernan, Oscar Suman, Celeste Finnerty

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Introduction: Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. Methods: Sixty-nine adult patients with burns covering ≥30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. Results: Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P <0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7% improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm<sup>2</sup> compared to control (P = 0.002). Conclusions: Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.

Original languageEnglish (US)
Article number217
JournalCritical Care
Volume19
Issue number1
DOIs
StatePublished - May 4 2015

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Propranolol
Wound Healing
Hemorrhage
Burns
Heart Rate
Skin Transplantation
Research Ethics Committees
Body Surface Area
Vasoconstriction
Hematocrit
Cosmetics
Vascular Resistance
Adrenergic Receptors
Hospitalization
Hemodynamics
Demography
Transplants
Control Groups
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults. / Ali, Arham; Herndon, David; Mamachen, Ashish; Hasan, Samir; Andersen, Clark R.; Grogans, Ro Jon; Brewer, Jordan L.; Lee, Jong; Heffernan, Jamie; Suman, Oscar; Finnerty, Celeste.

In: Critical Care, Vol. 19, No. 1, 217, 04.05.2015.

Research output: Contribution to journalArticle

Ali, A, Herndon, D, Mamachen, A, Hasan, S, Andersen, CR, Grogans, RJ, Brewer, JL, Lee, J, Heffernan, J, Suman, O & Finnerty, C 2015, 'Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults', Critical Care, vol. 19, no. 1, 217. https://doi.org/10.1186/s13054-015-0913-x
Ali A, Herndon D, Mamachen A, Hasan S, Andersen CR, Grogans RJ et al. Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults. Critical Care. 2015 May 4;19(1). 217. https://doi.org/10.1186/s13054-015-0913-x
Ali, Arham ; Herndon, David ; Mamachen, Ashish ; Hasan, Samir ; Andersen, Clark R. ; Grogans, Ro Jon ; Brewer, Jordan L. ; Lee, Jong ; Heffernan, Jamie ; Suman, Oscar ; Finnerty, Celeste. / Propranolol attenuates hemorrhage and accelerates wound healing in severely burned adults. In: Critical Care. 2015 ; Vol. 19, No. 1.
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abstract = "Introduction: Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. Methods: Sixty-nine adult patients with burns covering ≥30{\%} of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20{\%} from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. Results: Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P <0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7{\%} improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm2 compared to control (P = 0.002). Conclusions: Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.",
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AU - Ali, Arham

AU - Herndon, David

AU - Mamachen, Ashish

AU - Hasan, Samir

AU - Andersen, Clark R.

AU - Grogans, Ro Jon

AU - Brewer, Jordan L.

AU - Lee, Jong

AU - Heffernan, Jamie

AU - Suman, Oscar

AU - Finnerty, Celeste

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N2 - Introduction: Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. Methods: Sixty-nine adult patients with burns covering ≥30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. Results: Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P <0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7% improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm2 compared to control (P = 0.002). Conclusions: Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.

AB - Introduction: Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults. Methods: Sixty-nine adult patients with burns covering ≥30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge. Results: Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P <0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7% improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm2 compared to control (P = 0.002). Conclusions: Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.

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