Cardiovascular and Neurohumoral Responses Following Burn Injury

The systemic stress response to thermal injury in children

“…Other differences between the patterns of hormone release in children and adults are manifested in A II release. Whereas in children the peak of A II release was reached 6 h after admission, the peak of A II release in adults was not reached until the third day after injury ( Crum et al ., 1988 , 1990). The increase in A II concentration between 85 and 108 h in our study is also different from the adult response, but may be related to the severity of injury, since the surge in A II occurred more in the children with the biggest burns.…”

“…With the exception of one study ( Crum et al ., 1990 ), the mean plasma concentration of AVP in admission blood samples was higher in our burn‐injured children than values reported for adults ( Shirani et al ., 1983 ; Morgan et al ., 1980 ; Crum et al ., 1988 ), although the mean burn size of the patients in this study was lower (20.5%). In spite of the high admission concentrations, AVP levels in the children returned to just above normal levels by 24–36 h after admission, earlier than reported in adults.…”

“…Of the four, the osmoreceptor and the afferent pain receptor systems may be particularly relevant following burn injury. However, Crum et al . (1990 ), have suggested that neither osmotic nor volume stimuli are involved in altering the secretion of AVP following burn injury.…”

“…It is accompanied by severe metabolic derangement which is characterized by massive release of many hormones, including stress hormones. The complexity of the hormonal changes is only now being clearly understood in adults ( Crum et al ., 1988 , 1990), but data on the changes which accompany such injury in children are limited. It is, however, now recognized that burn injury in children is a special problem which has significant pathophysiological differences from that in adults ( Dobke, 1993).…”

Serum from human burn victims impairs myogenesis and protein synthesis in primary myoblasts

“…Numerous immunologic and endocrine factors have been found to be drastically different in serum obtained from burn patients when compared to control serum, such as: complement, C-reactive protein, interferon γ, TNF-α, interleukins-1β, 2, 4, 5, 6, 7, 8, 10, 12, 13, and 17, catecholamines, insulin-like growth factor-1 (IGF-1), IGF-1 binding protein-3 (IGFBP-3), growth hormone (GH), testosterone, thyroxine (T4), and cortisol (Crum et al, 1990; Jeffries and Vance, 1992; Jeschke et al, 2008; Merritt et al, 2012). Our data suggest that, despite large increases in circulating TNF-α and IL-6, the rise in these pro-inflammatory cytokines is not enough to activate downstream NFκB and STAT3 signaling in skeletal muscle for a prolonged period of time.…”