The Effect of Occlusive Dressings on the Energy Metabolism of Severely Burned Children

Abstract

Metabolic studies were performed on 23 burned children. They were studied sequentially until their burn wounds were healed. A metabolic study lasted 20 minutes, during which continuous measurements were made of O2 consumption and CO2 production rates, rectal temperature, average surface temperatures (dressings, skin and wound), body heat content, and rate of body weight loss using a bed scale. These measurements allowed solution of the heat balance equation for each study period. After 24 hours in a constant temperature room kept at 28 C and 40% relative humidity, metabolic studies were initiated when blood was drawn for catecholamine assay, followed by a metabolic analysis, after which dressings were removed and fresh silvadene applied to the wounds. No dressings were applied. Metabolic analyses were repeated after two and four hours of exposure, after which blood for catecholamine analysis was drawn and the study terminated. Without dressings in a thermally neutral environment, burn patients demonstrated an increased rate of heat loss of 27 watts/square meter body surface area (W/M2), compared with the predicted normal. The major portion of this increment is by evaporation, which increased 300%. The rate of heat production equals heat loss, and is increased 50% above the predicted normal. Occlusive dressings result in a 15 W/M2 decrease in the rate of heat loss, about evenly divided between evaporative and dry routes, with a corresponding 15 W/M2 decrease in the rate of heat production. Plasma catecholamine levels of bandaged burn patients are not significantly different from values for healed burn patients, and do not correlate with the rate of heat production. The increased heat production of burn patients is a response to an increased rate of heat loss, not vice versa. The use of occlusive dressings substantially reduces the energy requirements to manageable levels, even in patients with very large burns.

The Role of Exercise in the Rehabilitation of Patients with Severe Burns

“…In particular, burn injury results in a 20–100% increase in predicted resting energy expenditure (11, 20, 35), which persists for months if not years post injury (8). This increase in energy expenditure can be managed to an extent by β blockade (17, 19, 35), occlusive wound dressings (3), and keeping patients in a warm environment (~32°C) (35). Despite these management strategies, increased metabolic rate still poses a considerable challenge in providing sufficient nutrition to this patient group.…”

Effect of Ambient Temperature on Metabolic Rate After Thermal Injury

“…Normal volunteers and adult patients with burns involving more than 20% TBSA who had no evidence of systemic infection were included. These measurements were performed between postburn days 6 and 21 and at least 24 hours after an operative procedure. All patients were treated by the open method of wound care with dressings covering only recently grafted areas.…”

Severe Burn Injury Induces Thermogenically Functional Mitochondria in Murine White Adipose Tissue

“…Since burn trauma is associated with prolonged inflammatory (9, 10) and adrenergic stress (11–13), and a diminished capacity to thermoregulate (14, 15), we hypothesized that iWAT mitochondrial thermogenesis may contribute to burn-induced hypermetabolism. Indeed, others have reported an acute activation of intrascapular brown adipose tissue (BAT) in burned mice (16–18), supporting a role for adipose tissue mitochondrial thermogenesis in burn-induced hypermetabolism.…”