Body Composition Changes with Time in Pediatric Burn Patients

Przkora, René; Barrow, Robert E.; Jeschke, Marc G.; Suman, Oscar E.; Celis, Mario M.; Sanford, Arthur P.; Chinkes, David L.; Mlcak, Ronald P.; Herndon, David N.

doi:10.1097/01.ta.0000214580.27501.19

Cited by 102 publications

(93 citation statements)

References 8 publications

(14 reference statements)

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“…We have shown that loss of proteins, muscle, and bone persists up to 2 years postburn affecting patients' lives remarkably. 1,2 We, therefore, suggest that it is beneficial to attenuate the hypermetabolic response immediately postburn and subsequently preserve protein and amino acid stores. Agents known to affect postburn hypermetabolism and catabolism are insulin, IGF-I, oxandrolone, GH, and propranolol.…”

Section: Discussionmentioning

confidence: 99%

“…A hologic model QDR-4500W DEXA (Hologic Inc, Waltham, MA) was used to determine body composition as previously published. 1,2,18,19 Hormones, proteins, and cytokines Blood and/or urine was collected from burn patients at admission, pre-operatively, and 5 days post-operatively for 4 weeks for serum hormone, protein, cytokine and urine hormone analysis. Blood was drawn in a serum-separator collection tube and centrifuged for 10 minutes at 1320 rpm; the serum was removed and stored at −70°C until assayed.…”

Section: Body Compositionmentioning

confidence: 99%

“…[4][5][6][7] This hypermetabolic response begins on the fifth day post-injury and continues up to 24 months postburn causing loss of lean body mass (LBM), loss of bone density, muscle weakness, and poor wound healing. 1,4,8 The hypermetabolic response is associated with a marked acute phase response that persists for 8-12 weeks after the initial insult. 9,10 Hypermetabolism is further associated with alterations in the endocrinologic response.…”

Section: Introductionmentioning

confidence: 99%

“…We and others have shown that after a severe thermal injury, patients are hypermetabolic, disabled, and debilitated over a period of at least 24 months. 1,2 There is growing evidence that pathophysiologic responses that occur immediately or early after burn will affect long-term outcome of severely burned patients. 1,3 The inflammatory response starts immediately after burn and persists for up to several months.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 There is growing evidence that pathophysiologic responses that occur immediately or early after burn will affect long-term outcome of severely burned patients. 1,3 The inflammatory response starts immediately after burn and persists for up to several months. 3 The hypermetabolic response following major burn is characterized by a hyperdynamic response with increased body temperature, oxygen and glucose consumption, CO 2 production, glycogenolysis, proteolysis, lipolysis, and futile substrate cycling.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The Pathophysiologic Response to Severe Burn Injury.

Jeschke

Finnerty

Norbury

et al. 2006

Critical Care Medicine

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Objective-To improve clinical outcome and to determine new treatment options, we studied the pathophysiologic response postburn in a large prospective, single center, clinical trial.Summary Background Data-A severe burn injury leads to marked hypermetabolism and catabolism, which are associated with morbidity and mortality. The underlying pathophysiology and the correlations between humoral changes and organ function have not been well delineated.Methods-Two hundred forty-two severely burned pediatric patients [>30% total body surface area (TBSA)], who received no anabolic drugs, were enrolled in this study. Demographics, clinical data, serum hormones, serum cytokine expression profile, organ function, hypermetabolism, muscle protein synthesis, incidence of wound infection sepsis, and body composition were obtained throughout acute hospital course.Results-Average age was 8 ± 0.2 years, and average burn size was 56 ± 1% TBSA with 43 ± 1% third-degree TBSA. All patients were markedly hypermetabolic throughout acute hospital stay and had significant muscle protein loss as demonstrated by a negative muscle protein net balance (−0.05% ± 0.007 nmol/100 mL leg/min) and loss of lean body mass (LBM) (−4.1% ± 1.9%); P < 0.05. Patients lost 3% ± 1% of their bone mineral content (BMC) and 2 ± 1% of their bone mineral density (BMD). Serum proteome analysis demonstrated profound alterations immediately postburn, which remained abnormal throughout acute hospital stay; P < 0.05. Cardiac function was compromised immediately after burn and remained abnormal up to discharge; P < 0.05. Insulin resistance appeared during the first week postburn and persisted until discharge. Patients were hyperinflammatory with marked changes in IL-8, MCP-1, and IL-6, which were associated with 2.5 ± 0.2 infections and 17% sepsis.Conclusions-In this large prospective clinical trial, we delineated the complexity of the postburn pathophysiologic response and conclude that the postburn response is profound, occurring in a timely manner, with derangements that are greater and more protracted than previously thought.

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Section: Discussionmentioning

confidence: 99%