BACKGROUND The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of the use of adrenergic blockade after burn injury

Flores, Orlando

Muller, Michael J.

Paratz, Jennifer D.

Roberts, Jason A.

Stockton, Kellie

Journal of Trauma and Acute Care Surgery

BACKGROUND: The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce
multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned
patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of
the use of adrenergic blockade after burn injury.
METHODS: The databases MEDLINE via OVID, PubMed, EMBASE, CINAHL, Cochrane Library, and Web of Science were searched
from inception to December 2014 with search terms including burns and beta-blockers with appropriate synonyms. Articles
were restricted to those published in English, French, or Spanish. Randomized controlled trials, nonrandomized controlled
trials, and systematic reviews were screened. After an independent screening and full-text review, 10 articles were selected, and
an appraisal of risk of bias was performed.
RESULTS: From 182 articles screened, 9 randomized controlled trials and 1 nonrandomized controlled trial met the inclusion criteria.
Pooled analyses were performed to calculate effect sizes and 95% confidence intervals (CIs). There was a positive effect
favoring propranolol use that significantly decreased resting energy expenditure (g = j0.64; 95% CI, j0.8 to j0.5; p G 0.001)
and trunk fat (g = j0.3; 95% CI, j0.4 to j0.1; p G 0.001) as well as improved peripheral lean mass (g = 0.45; 95% CI, 0.3Y0.6;
p G 0.001) and insulin resistance (g = j1.35; 95% CI, j2.0 to j0.6; p G 0.001). Occurrence of adverse events was not
significantly different between the treated patients the and controls.
CONCLUSION: Limited evidence suggests beneficial effects of propranolol after burn injury, and its use seems safe. However, further trials on
adult population with a broader range of outcome measures are warranted.
LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III.Full Tex

Paratz, Jenny

Griffith Research Online

The efficacy and safety of adrenergic blockade post burn injury: A systematic review and meta-analysis

Orlando Flores

Kellie Stockton

Jason A. Roberts

Michael J. Muller

Jennifer D. Paratz

Crossref

The efficacy and safety of adrenergic blockade after burn injury

BACKGROUND: The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce
multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned
patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of
the use of adrenergic blockade after burn injury.
METHODS: The databases MEDLINE via OVID, PubMed, EMBASE, CINAHL, Cochrane Library, and Web of Science were searched
from inception to December 2014 with search terms including burns and beta-blockers with appropriate synonyms. Articles
were restricted to those published in English, French, or Spanish. Randomized controlled trials, nonrandomized controlled
trials, and systematic reviews were screened. After an independent screening and full-text review, 10 articles were selected, and
an appraisal of risk of bias was performed.
RESULTS: From 182 articles screened, 9 randomized controlled trials and 1 nonrandomized controlled trial met the inclusion criteria.
Pooled analyses were performed to calculate effect sizes and 95% confidence intervals (CIs). There was a positive effect
favoring propranolol use that significantly decreased resting energy expenditure (g = j0.64; 95% CI, j0.8 to j0.5; p G 0.001)
and trunk fat (g = j0.3; 95% CI, j0.4 to j0.1; p G 0.001) as well as improved peripheral lean mass (g = 0.45; 95% CI, 0.3Y0.6;
p G 0.001) and insulin resistance (g = j1.35; 95% CI, j2.0 to j0.6; p G 0.001). Occurrence of adverse events was not
significantly different between the treated patients the and controls.
CONCLUSION: Limited evidence suggests beneficial effects of propranolol after burn injury, and its use seems safe. However, further trials on
adult population with a broader range of outcome measures are warranted.
LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III.Full Tex

University of Queensland eSpace

The efficacy and safety of adrenergic blockade post burn injury: a systematic review and meta-analysis

http://espace.library.uq.edu.au/view/UQ:372995/UQ372995_OA.pdf

The efficacy and safety of adrenergic blockade post burn injury: a systematic review and meta-analysis

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