Cardiorespiratory Capacity and Strength Remain Attenuated in Children with Severe Burn Injuries at Over 3 Years Postburn

Cambiaso‐Daniel, Janos; Rivas, Eric; Carson, Joshua; Hundeshagen, Gabriel; Lopez, Omar Nunez; Glover, Shauna; Herndon, David N.; Suman, Oscar E.

doi:10.1016/j.jpeds.2017.09.015

Cited by 18 publications

(37 citation statements)

References 37 publications

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“…Prior assessment of exercise capacity with the Steep Ramp Test (SRT) predicted exercise capacity 6 months after discharge, and can therefore be used to identify "at risk" patients at an early stage. Until now, all longitudinal studies on exercise capacity during the first year after pediatric burns were performed by the research group of the Shriners Hospital for Children in Galveston, U.S.A. [6,[14][15][16][17][18][22][23][24][25][26][27]. It is hard to make a fair comparison between these studies and our findings, as the Galveston patients suffered from more extensive burns compared to our participants (>30% or >40% versus <35% TBSA burned, respectively).…”

Section: Discussionmentioning

confidence: 68%

“…no control groups). This current exercise regime leads to even larger improvements in exercise capacity (up to 30%) [22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 96%

“…These studies included children and adolescents with extensive burns (>30% or >40% of total body surface area (TBSA)). In this exceptional group of patients, exercise capacity was shown to be affected up to 5 years post-burn, despite significant improvements caused by structured exercise and/or drug interventions [14][15][16]20,21,[24][25][26][27]. Fortunately, such extensive pediatric burns are rare in both the Netherlands and the U.S.A. [28], and this will also be the case in other developed countries.…”

Section: Introductionmentioning

confidence: 90%

“…The majority of evidence regarding exercise capacity after pediatric burns originates from the Shriners Hospital for Children in Galveston, U.S.A. [6,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]. These studies included children and adolescents with extensive burns (>30% or >40% of total body surface area (TBSA)).…”

Section: Introductionmentioning

confidence: 99%

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Predictability of exercise capacity following pediatric burns: a preliminary investigation

Akkerman

Mouton

Groot

et al. 2019

Disability and Rehabilitation

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Purpose: Describe the course of exercise capacity in pediatric burn patients during the initial 6 months after hospital discharge, and examine whether its recovery can be predicted from burn characteristics, sociodemographic characteristics, and/or prior assessment. Materials and methods: Exercise capacity was assessed at discharge, and 6 weeks, 3 months, and 6 months after discharge using the Steep Ramp Test (SRT). Results: Twenty-four pediatric patients with burns affecting 0.1-34% of total body surface area were included. At group level, exercise capacity was low at discharge and did not reach healthy reference values within 6 months, despite significant improvement over time. At individual level, the course of exercise capacity varied widely. Six months after discharge, 48% of participants scored more than one standard deviation below healthy age-and sex-specific reference values. SRT outcomes at 6 weeks and 3 months were the best predictors of exercise capacity 6 months after discharge, explaining, respectively, 76% and 93% of variance. Conclusions: Forty-eight percent of participants did not achieve healthy reference values of exercise capacity and were therefore considered "at risk" for diminished functioning. Our preliminary conclusion that early assessment of exercise capacity with the SRT can timely identify those patients, needs to be strengthened by further research. ä IMPLICATIONS FOR REHABILITATIONPediatric burns can be considered as a chronic medical condition because of the lifelong consequences. Exercise capacity is reduced following-even minor -pediatric burns. Recovery patterns vary widely: some pediatric burn patients achieve healthy levels of exercise capacity without specific intervention, while others do not. The Steep Ramp Test can be used to assess exercise capacity, identifying those "at risk" for adverse outcomes at an early stage.Patients "at risk" should be encouraged to play sports and adopt an active lifestyle.

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Section: Discussionmentioning

confidence: 68%

“…no control groups). This current exercise regime leads to even larger improvements in exercise capacity (up to 30%) [22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictability of exercise capacity following pediatric burns: a preliminary investigation

Akkerman

Mouton

Groot

et al. 2019

Disability and Rehabilitation

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“…A key outcome for exercise rehabilitation and prognosis is a patient’s maximal oxygen consumption (VO 2 max [mL/kg/min]), since it indicates cardiorespiratory fitness and endurance and remains attenuated for several years post-burn [7–9]. A commonly used method for measuring VO 2 max during exercise is indirect calorimetry.…”

Section: Introductionmentioning

confidence: 99%

Estimated versus achieved maximal oxygen consumption in severely burned children maximal oxygen consumption in burned children

Tapking

Popp

Herndon³

et al. 2018

Burns

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Rehabilitative Exercise Training for Burn Injury

et al. 2021

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Due to improvements in acute burn care over the last few decades, most patients with severe burns (up to 90% of the total body surface) survive. However, the metabolic and cardiovascular complications that accompany a severe burn can persist for up to three years post injury. Accordingly, there is now a greater appreciation of the need for strategies that can hasten recovery and reduce long-term morbidity post burn. Rehabilitation exercise training (RET) is a proven effective treatment to restore lean body mass, glucose and protein metabolism, cardiorespiratory fitness, and muscle strength in burn survivors. Despite this, very few hospitals incorporate RET in programs to aid the rehabilitation of patients with severe burns. Given that RET is a safe and efficacious treatment that restores function and reduces post burn morbidity, we propose that a long-term exercise prescription plan should be considered for all patients with severe burns. In this literature review, we discuss the current understanding of burn trauma on major organ systems, and the positive benefits of incorporating RET as a part of the long-term rehabilitation of severely burned individuals. We also provide burn-specific exercise prescription guidelines for clinical exercise physiologists.

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Cardiorespiratory Capacity and Strength Remain Attenuated in Children with Severe Burn Injuries at Over 3 Years Postburn

Cited by 18 publications

References 37 publications

Predictability of exercise capacity following pediatric burns: a preliminary investigation

Predictability of exercise capacity following pediatric burns: a preliminary investigation

Estimated versus achieved maximal oxygen consumption in severely burned children maximal oxygen consumption in burned children

Rehabilitative Exercise Training for Burn Injury

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