Long-Term Propranolol Use in Severely Burned Pediatric Patients
Annals of Surgery
Year, Volume, Issue, Page(s):
2012, vol. 256, issue 3, pp 402-411
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 burnswere randomized to control (n=89) or 4mg/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. This study is registered at clinicaltrials.gov:
Herndon DN, Rodriguez NA, Diaz EC, Hegde S, Jennings K, Mlcak RP, Suri JS, Lee JO, Williams FN, Meyer W, Suman OE, Barrow RE, Jeschke MG, Finnerty CC.
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