Effects of Propranolol in Accelerating Wound Healing and Attenuation of Hypermetabolism in Adult Burn Patients

Cheema, Saeed Ashraf; Ahmed, Urwa Tanveer; Nasir, Hafsa; Dogar, Shumaila Rehman; Mustafa, Zunaisra

doi:10.29271/jcpsp.2020.01.46

Cited by 11 publications

(18 citation statements)

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“…The length of stay in hospital reflects the situation of recovery. According to our results, the use of propranolol does not shorten the time of stay in hospital 11,[15][16][17]20,21 (WMD = −3.97, 95% CIs [−8.21, 0.27], P = .07, I 2 = 99%). Similarly, there is no significant difference in the subgroup of children 15,16,20 (WMD = 0.10, 95% CIs [−4.50, 4.69], P = .97, I 2 = 99%), but the results in the subgroup of adults are statistically significant 11,17,21 (WMD = −9.06, 95% CIs [−12.88, −5.24], P = .09, I 2 = 59%) ( Figure 3).…”

Section: Length Of Stay In Hospital (D)mentioning

confidence: 59%

“…9,24,25 The latest meta-analysis 9 included eight studies in quantitative synthesis and indicated that there were no differences in mortality or sepsis, while the use of propranolol in burned patients resulted in lower values of HR. As a few new RCTs [10][11][12][13][14][15][16][17][18][19][20][21] have been reported recently, we conducted this systematic review and metaanalysis to evaluate the effectiveness and safety of beta blocker in burned patients. We further confirmed that the use of beta antagonist in burned patients has no significant effect on sepsis and mortality and reduced HR.…”

Section: Discussionmentioning

confidence: 99%

“…Ten trials were performed in the United States, and the remaining two were in Iran 17 and Pakistanp. 21 Almost all RCTs included patients with burns greater than 20% of TBSA, only one trial 18 limited the TBSA ≤20%. Interventions and comparisons were very similar, with propranolol (titrated to decrease HR by 20% of admission HR) and placebo or standard care being the intervention and comparison.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Two studies 17,21 showed that using propranolol reduced preparation time before transplant surgery. Based on these results, we made a forest plot for the time ready for graft.…”

Section: Time Ready For Graft (D)mentioning

confidence: 99%

“…4,8 However, Nunez 9 et al synthesised the relevant researches and indicated that the mortality and sepsis of burn patients treated with propranolol were not significantly different from the control group, and there was also insufficient evidence to prove that the use of propranolol could reduce the length of hospital stay among burned patients. More and more randomised controlled trials (RCTs) [10][11][12][13][14][15][16][17][18][19][20][21] have been published in recent years. We performed a meta-analysis with the updated data, hoping to provide more evidence to evaluate the effectiveness and safety of using beta blocker in burned patients.…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness and safety of beta antagonist in burned patients: A systematic review and meta‐analysis

Feng

et al. 2020

International Wound Journal

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Beta antagonist is one of the most effective and the least toxic pharmacological treatments to attenuate the raised catecholamine effects for burned patients. To evaluate the effectiveness and safety of beta blocker compared with placebo or usual care in burned patients, a meta‐analysis of randomised controlled trials (RCTs) was conducted. We searched the database of PubMed, Embase, the Cochrane Library, and Web of Science to 10 April 2020. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We performed the meta‐analysis using a random‐effect model. A total of 12 RCTs were included in the study, including 1887 patients. Propranolol‐treated patients have a decrease in length of hospital stay in adults (weighted mean difference [WMD] = −9.06, 95% CIs = [−12.88, −5.24]) and prepare time of graft (WMD = −7.88, 95% CIs = [−12.27, −3.50]). Similarly, the use of propranolol could significantly decrease heart rate (WMD = −15.16, 95% CIs = [−20.37, −9.94]), rate pressure product (WMD = −1.32, 95% CIs = [−1.67, −0.97]), and mean arterial pressure (WMD = −2.75, 95% CIs = [−4.23, −1.26]). Moreover, there is no significant difference between propranolol and placebo with respect to mortality (risk difference [RD] = 0.00, 95% CIs [−0.03, 0.04]), sepsis (RD = −0.03, 95% CIs [−0.09, 0.03]), and events of post‐traumatic stress disorder (PTSD) and acute stress disorder (RD = −0.01, 95% CIs [−0.07, 0.05]), and also, there is no significant difference in subgroup analysis based on age. The use of beta antagonist in burned patients does reduce length of hospital stay in adults, shorten the preparation time for graft, and reduce heart burden, without increasing mortality, sepsis, or PTSD compared with those who had usual care or placebo. So beta antagonist can be considered as an appropriate treatment strategy in burned patients. More prospective, randomised‐controlled, multi‐centre studies were needed to define their place in therapeutic algorithms.

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Section: Length Of Stay In Hospital (D)mentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Two studies 17,21 showed that using propranolol reduced preparation time before transplant surgery. Based on these results, we made a forest plot for the time ready for graft.…”

Section: Time Ready For Graft (D)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effectiveness and safety of beta antagonist in burned patients: A systematic review and meta‐analysis

Feng

et al. 2020

International Wound Journal

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Mechanism and application of β‐adrenoceptor blockers in soft tissue wound healing

Jia

Wang

et al. 2023

Medicinal Research Reviews

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Soft tissue damage stimulates sympathetic nerves to release large amounts of catecholamine hormones which bind to β‐adrenergic receptors (β‐ARs) on the cell membrane surface. It activates the downstream effector molecules and impairs soft tissue wound healing. β‐blockers specifically inhibit β‐ARs activation in acute/chronic skin lesions and ulcerative hemangiomas. They also accelerate soft tissue wound healing by shortening the duration of inflammation, speeding keratinocyte migration and reepithelialization, promoting wound contraction and angiogenesis, and inhibiting bacterial virulence effects. In addition, β‐blockers shorten wound healing periods in patients with severe thermal damage by reducing the hypermetabolic response. While β‐blockers promote/inhibit corneal epithelial cell regeneration and restores limbal stem/progenitor cells function, it could well accelerate/delay corneal wound healing. Given these meaningful effects, a growing number of studies are focused on examining the efficacy and safety of β‐blockers in soft tissue wound repair, including acute and chronic wounds, severe thermal damage, ulcerated infantile hemangioma, corneal wounds, and other soft tissue disorders. However, an intensive investigation on their acting mechanisms is imperatively needed. The purpose of this article is to summerize the roles of β‐blockers in soft tissue wound healing and explore their clinical applications.

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The effect of propanolol and metformin on clinical outcomes in burns patients: A systematic review and meta-analysis

Riasa

Kawilarang

2023

Burns Open

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Effects of Propranolol in Accelerating Wound Healing and Attenuation of Hypermetabolism in Adult Burn Patients

Cited by 11 publications

References 0 publications

The effectiveness and safety of beta antagonist in burned patients: A systematic review and meta‐analysis

The effectiveness and safety of beta antagonist in burned patients: A systematic review and meta‐analysis

Mechanism and application of β‐adrenoceptor blockers in soft tissue wound healing

The effect of propanolol and metformin on clinical outcomes in burns patients: A systematic review and meta-analysis

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