Reversal of catabolism by beta-blockade after severe burns

David Herndon, David W. Hart, Steven Wolf, David L. Chinkes, Robert R. Wolfe

Research output: Contribution to journalArticle

430 Citations (Scopus)

Abstract

Background: The catecholamine-mediated hypermetabolic response to severe burns causes increased energy expenditure and muscle-protein catabolism. We hypothesized that blockade of β-adrenergic stimulation with propranolol would decrease resting energy expenditure and muscle catabolism in patients with severe burns. Methods: Twenty-five children with acute and severe burns (more than 40 percent of total body-surface area) were studied in a randomized trial. Thirteen received oral propranolol for at least two weeks, and 12 served as untreated controls. The dose of propranolol was adjusted to decrease the resting heart rate by 20 percent from each patient's base-line value. Resting energy expenditure and skeletal-muscle protein kinetics were measured before and after two weeks of beta-blockade (or no therapy, in controls). Body composition was measured serially throughout hospitalization. Results: Patients in the control group and the propranolol group were similar with respect to age, weight, percentage of total body-surface area burned, percentage of body-surface area with third-degree burns, and length of time from injury to metabolic study. Beta-blockade decreased the heart rates and resting energy expenditure in the propranolol group, both as compared with the base-line values (P<0.001 and P=0.01, respectively) and as compared with the values in the control group (P=0.03 and P=0.001, respectively). The net muscle-protein balance increased by 82 percent over base-line values in the propranolol group (P=0.002), whereas it decreased by 27 percent in the control group (P not significant). The fat-free mass, as measured by whole-body potassium scanning, did not change substantially in the propranolol group, whereas it decreased by a mean (±SE) of 9±2 percent in the control group (P=0.003). Conclusions: In children with burns, treatment with propranolol during hospitalization attenuates hypermetabolism and reverses muscle-protein catabolism.

Original languageEnglish (US)
Pages (from-to)1223-1229
Number of pages7
JournalNew England Journal of Medicine
Volume345
Issue number17
DOIs
StatePublished - Oct 25 2001

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Burns
Propranolol
Muscle Proteins
Energy Metabolism
Body Surface Area
Control Groups
Hospitalization
Heart Rate
Whole Body Imaging
Body Composition
Adrenergic Agents
Catecholamines
Potassium
Skeletal Muscle
Fats
Weights and Measures
Muscles
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Reversal of catabolism by beta-blockade after severe burns. / Herndon, David; Hart, David W.; Wolf, Steven; Chinkes, David L.; Wolfe, Robert R.

In: New England Journal of Medicine, Vol. 345, No. 17, 25.10.2001, p. 1223-1229.

Research output: Contribution to journalArticle

Herndon, D, Hart, DW, Wolf, S, Chinkes, DL & Wolfe, RR 2001, 'Reversal of catabolism by beta-blockade after severe burns', New England Journal of Medicine, vol. 345, no. 17, pp. 1223-1229. https://doi.org/10.1056/NEJMoa010342
Herndon, David ; Hart, David W. ; Wolf, Steven ; Chinkes, David L. ; Wolfe, Robert R. / Reversal of catabolism by beta-blockade after severe burns. In: New England Journal of Medicine. 2001 ; Vol. 345, No. 17. pp. 1223-1229.
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AB - Background: The catecholamine-mediated hypermetabolic response to severe burns causes increased energy expenditure and muscle-protein catabolism. We hypothesized that blockade of β-adrenergic stimulation with propranolol would decrease resting energy expenditure and muscle catabolism in patients with severe burns. Methods: Twenty-five children with acute and severe burns (more than 40 percent of total body-surface area) were studied in a randomized trial. Thirteen received oral propranolol for at least two weeks, and 12 served as untreated controls. The dose of propranolol was adjusted to decrease the resting heart rate by 20 percent from each patient's base-line value. Resting energy expenditure and skeletal-muscle protein kinetics were measured before and after two weeks of beta-blockade (or no therapy, in controls). Body composition was measured serially throughout hospitalization. Results: Patients in the control group and the propranolol group were similar with respect to age, weight, percentage of total body-surface area burned, percentage of body-surface area with third-degree burns, and length of time from injury to metabolic study. Beta-blockade decreased the heart rates and resting energy expenditure in the propranolol group, both as compared with the base-line values (P<0.001 and P=0.01, respectively) and as compared with the values in the control group (P=0.03 and P=0.001, respectively). The net muscle-protein balance increased by 82 percent over base-line values in the propranolol group (P=0.002), whereas it decreased by 27 percent in the control group (P not significant). The fat-free mass, as measured by whole-body potassium scanning, did not change substantially in the propranolol group, whereas it decreased by a mean (±SE) of 9±2 percent in the control group (P=0.003). Conclusions: In children with burns, treatment with propranolol during hospitalization attenuates hypermetabolism and reverses muscle-protein catabolism.

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