Improved myocardial oxygen utilization following propranolol infusion in adolescents with postburn hypermetabolism

Minifee, Paul K.; Barrow, Robert E.; Abston, Sally; Desai, M. H.; Herndon, David N.

doi:10.1016/s0022-3468(89)80541-x

Cited by 61 publications

(38 citation statements)

References 21 publications

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“…Propranolol mitigates the degree and extent of hypermetabolism, hyper-catabolism, and immune dysfunction experienced by these patients. 12, 13 Clinically, propranolol decreases tachycardia and decreases myocardial oxygen consumption of pediatric burn patients 11, 14, 15. When given to decrease resting heart rate 15–20% of admission heart rate, propranolol increases lean body mass and decreases resting energy expenditure over time compared to children receiving standard care 11.…”

Section: Introductionmentioning

confidence: 99%

Propranolol decreases cardiac work in a dose-dependent manner in severely burned children

Williams

Herndon

Kulp

et al. 2011

Surgery

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Background Severe burn is followed by profound cardiac stress. Propranolol, a non selective β1, β2-receptor antagonist, decreases cardiac stress, but little is known about the dose necessary to cause optimal effect. Thus, the aim of this study was to determine in a large prospective randomized controlled trial the dose of propranolol that would decrease heart rate at least 15% of admission heart rate and improve cardiac function. Four-hundred six patients with burns >30% total body surface area (TBSA) were enrolled and randomized to receive standard care (controls, n=235) or standard care plus propranolol (n=171). Methods Dose-response and drug kinetics of propranolol were performed. Heart rate and mean arterial pressure were measured continuously. Cardiac output (CO), cardiac index (CI), stroke volume (SV), rate pressure product, and cardiac work (CW) were determined at regular intervals. Statistical analysis was performed using ANOVA with Tukey and Bonferroni corrections and Student’s t-test when applicable. Significance was accepted at p<0.05. Results Propranolol given initially at 1 mg/kg/day decreased heart rate by 15% compared to control patients but was increased to 4 mg/kg/day within the first 10 days to sustain treatment benefits (p<0.05). Propranolol decreased CO, rate pressure product, and CW without deleterious effects on mean arterial pressure. The effective plasma drug concentrations were achieved in 30 minutes, and the half-life was 4 hours. Conclusions The data suggest that propranolol is an efficacious modulator of the post-burn cardiac response when given at a dose of 4 mg/kg/day, which decreases and sustains heart rate 15% below admission heart rate.

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Section: Introductionmentioning

confidence: 99%

Propranolol decreases cardiac work in a dose-dependent manner in severely burned children

Williams

Herndon

Kulp

et al. 2011

Surgery

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“…As a medication for hypermetabolism and catabolism, propranolol is used for burn patients in the acute recovery phase. Supraphysiologic thermogenesis [23], tachycardia [24], cardiac work [25], and resting energy expenditure have been attenuated with propranolol administration [26,27]. Decreased cardiovascular morbidity and decreased overall mortality have also been documented in adult nontrauma patients given propranolol for the control of tachycardia after a major surgical procedure [28].…”

Section: Introductionmentioning

confidence: 99%

Propranolol as a modulator of M2b monocytes in severely burned patients

Kobayashi

Jeschke

Asai

et al. 2011

Journal of Leukocyte Biology

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A role of immunosuppressive M2 monocytes (IL-12(-)IL-10(+)) on the increased susceptibility of severely burned patients to various opportunistic pathogens has been described. Among M2 monocyte subpopulations, M2b monocytes (IL-17(-)CCL1(+)CXCL13(-)) are predominantly present in the peripheral blood of severely burned patients. In the present study, the rise and fall of M2b monocytes were examined in severely burned patients treated with propranolol. Catecholamine is known as an inducer of M2 monocytes, and propranolol is a competitive blocker of catecholamine binding to β-adrenergic receptors. Twenty-two children with 30% or more TBSA burn were enrolled in the study. Propranolol at a dose of 4 mg/kg/day was administered to these patients by feeding-tube or mouth. Burn patient monocytes exhibited weak bactericidal activity. IL-12 was produced by propranolol-treated patient monocytes after stimulation with Staphylococcus aureus antigen, and the production of IL-10, CCL1, CCL17, or CXCL13 by these monocytes was not demonstrated. These results indicate that a predominance of M2b monocytes in severely burned patients is intervened by the propranolol treatment. The increased susceptibility, to be associated with the appearance of M2b monocytes, of severely burned patients to opportunistic pathogens might be controlled by propranolol.

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“…[2][3][4] This highly conserved systemic response to injury is characterized by development of a hyperdynamic circulation, 5 resetting of the hypothalamic temperature regulation point, 4,6 elevated basal energy expenditure, 7 peripheral insulin resistance with hyperglycemia, 8 -10 increased peripheral lipolysis, 9 altered immune function, 11 and skeletal muscle protein catabolism. 12 We and others have attenuated supraphysiologic thermogenesis, 12 tachycardia, 13 cardiac work, 14 and resting energy expenditure 16 with administration of a nonselective ␤1/␤2-blocking agent (propranolol) after severe burn. Decreased cardiac morbidity and diminished overall mortality have been documented in non-trauma patients who were given ␤-blockers for control of tachycardia after iatrogenic tissue trauma inflicted by a major surgical procedure.…”

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Propranolol Does Not Increase Inflammation, Sepsis, or Infectious Episodes in Severely Burned Children

Jeschke¹,

Norbury²,

Finnerty³

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Improved myocardial oxygen utilization following propranolol infusion in adolescents with postburn hypermetabolism

Cited by 61 publications

References 21 publications

Propranolol decreases cardiac work in a dose-dependent manner in severely burned children

Propranolol decreases cardiac work in a dose-dependent manner in severely burned children

Propranolol as a modulator of M2b monocytes in severely burned patients

Propranolol Does Not Increase Inflammation, Sepsis, or Infectious Episodes in Severely Burned Children

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