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Wolf, Steven L.; Thomas, Stephen B.; Dasu, Mohan; Ferrando, Arny A.; Chinkes, David L.; Wolfe, Robert R.; Herndon, David N.

doi:10.1097/00000658-200306000-00008

Cited by 18 publications

(17 citation statements)

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“…More research is needed to optimize insulin delivery, as many recombinant growth factors, such as epidermal growth factor and transforming growth factor, are often cost prohibitive [93]. Other anabolic agents, such as oxandrolone, have been shown to increase lean body mass recovery, decrease length of stay, and improve overall outcomes, including wound healing [97–100]. Additionally, while conventional theory suggests that hemoglobin levels must be maintained above 10 g/dl to promote wound healing [101], preliminary evidence suggests that mild to moderate anemia has no effect on graft success if perfusion is maintained with proper circulatory volume [102].…”

Section: Optimization Of Burn Wound Healingmentioning

confidence: 99%

Burn wound healing and treatment: review and advancements

et al. 2015

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Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.

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Section: Optimization Of Burn Wound Healingmentioning

confidence: 99%

Burn wound healing and treatment: review and advancements

et al. 2015

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“…Recently, propranolol treatment for 1-year postburn was shown to improve peripheral lean body mass accumulation [28]. Oxandrolone, a synthetic androgen, has been shown to blunt hypermetabolism, improve bone mineral content and density, and increase the accretion of lean body mass in children with severe burn [29–32]. Recombinant human growth hormone (rHGH) has been found to reduce hypermetabolism and improve lean body mass accretion after burn, but its use has been limited because of two multicenter trials showing that growth hormone therapy increased mortality in critically ill adults [33–35].…”

Section: Reviewmentioning

confidence: 99%

Nutrition and metabolism in burn patients

et al. 2017

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Severe burn causes significant metabolic derangements that make nutritional support uniquely important and challenging for burned patients. Burn injury causes a persistent and prolonged hypermetabolic state and increased catabolism that results in increased muscle wasting and cachexia. Metabolic rates of burn patients can surpass twice normal, and failure to fulfill these energy requirements causes impaired wound healing, organ dysfunction, and susceptibility to infection. Adequate assessment and provision of nutritional needs is imperative to care for these patients. There is no consensus regarding the optimal timing, route, amount, and composition of nutritional support for burn patients, but most clinicians advocate for early enteral nutrition with high-carbohydrate formulas.Nutritional support must be individualized, monitored, and adjusted throughout recovery. Further investigation is needed regarding optimal nutritional support and accurate nutritional endpoints and goals.

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“…Several investigators showed that muscle protein synthesis was increased (7), unaltered (8), or even decreased (9) after severe burn, in separate studies. There is also divergent data regarding cellular loss and regrowth in response to burn.…”

Section: Introductionmentioning

confidence: 99%

Skeletal Muscle Loss is Associated with TNF Mediated Insufficient Skeletal Myogenic Activation After Burn

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Saeman

Libero

et al. 2015

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Muscle loss accompanies severe burn; in this hyper-catabolic state, muscle undergoes atrophy through protein degradation and disuse. Muscle volume is related to the relative rates of cellular degradation and myogenesis. We hypothesize that muscle atrophy after injury is in part due to insufficient myogenesis associated with the hyper-inflammatory response. The aim of the study is to investigate the role of skeletal myogenesis and muscle cell homeostasis in response to severe burn. Twenty-eight male C57BL6 mice received 25% TBSA scald. Gluteus muscle from these animals was analysed at day 1, 3, 7 and 14 after injury. Six additional animals without burn served as controls. We showed muscle wet weight and protein content decreased at day 3 and 7 after burn, with elevated TNF mRNA expression (p< 0.05). Increased cell death was observed through TUNEL staining, and cleaved caspase-3 levels reached a peak in muscle lysate at day 3 (p < 0.05). The cell proliferation marker PCNA significantly increased after burn, associated with increased gene and protein expression of myogenesis markers Pax7 and myogenin. However, desmin mRNA expression and the ratio of desmin to PCNA protein expression significantly decreased at day 7 (p < 0.05). In vitro, the ratio of desmin to PCNA protein expression significantly decreased in C2C12 murine myoblasts after TNF-α stimulation for 24 hours. We showed that severe burn induces both increased cell death and proliferation. However, myogenesis does not counterbalance increased cell death after burn. Data suggest insufficient myogenesis might be associated with pro-inflammatory mediator TNF activity.

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Abstract: Oxandrolone improves protein net balance and lean mass in the severely burned. These changes are associated with increased gene expression for functional muscle proteins.

Cited by 18 publications

References 0 publications

Burn wound healing and treatment: review and advancements

Burn wound healing and treatment: review and advancements

Nutrition and metabolism in burn patients

Skeletal Muscle Loss is Associated with TNF Mediated Insufficient Skeletal Myogenic Activation After Burn

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