The Safety and Efficacy of Propranolol in Reducing the Hypermetabolic Response in the Pediatric Burn Population

Sylvia Ojeda, Emily Blumenthal, Pamela Stevens, Clark R. Andersen, Lucy Robles, David N. Herndon, Walter J. Meyer

Research output: Contribution to journalArticle

Abstract

Pediatric burn patients often have hypertension and tachycardia for several years post-injury. Propranolol has shown to be effective in treating the hypermetabolic state secondary to a major burn injury. This study was conducted to document a safe and effective dosing regimen for three different age groups. One hundred four burn-injured children with a 30% to 92% total body surface area burn were treated for 1 to 2 years with propranolol in the outpatient setting. Guardians of the patients were instructed on how to take and monitor the systolic blood pressure and heart rate, and document their vital signs several times a day. The documentation was reviewed with the guardian and patient, and based on age-specific vital sign parameters, propranolol dosing adjustment was done to measure at least 15% to 20% reduction in admission heart rate. Mean doses for the age groups were as follows: 0 to 3 years 5.2 ± 2.8 mg/kg/day, 4 to 10 years 4.2 ± 1.8 mg/kg/day, and 11 to 18 years 2.9 ± 1.4 mg/kg/ day. The propranolol dose decreased as time post-burn increased. On selected patients, propranolol was stopped due to changes in the heart rate, but at all times, it was safe and effective. No adverse effects were noted. The dosing regimen was not affected by burn size or gender. Propranolol can be safely stopped abruptly with no rebound hypertension. Individuals older than 10 years required a lower dose per kilogram following the burn injury than prepubertal burn survivors. Propranolol proved to be both safe and effective in the management of cardiovascular changes occurring in the hypermetabolic state.

Original languageEnglish (US)
Pages (from-to)963-969
Number of pages7
JournalJournal of Burn Care and Research
Volume39
Issue number6
DOIs
StatePublished - Oct 23 2018

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

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    Ojeda, S., Blumenthal, E., Stevens, P., Andersen, C. R., Robles, L., Herndon, D. N., & Meyer, W. J. (2018). The Safety and Efficacy of Propranolol in Reducing the Hypermetabolic Response in the Pediatric Burn Population. Journal of Burn Care and Research, 39(6), 963-969. https://doi.org/10.1093/jbcr/iry014