The Hypermetabolic Response to Burn Injury and Interventions to Modify this Response

Abstract

SYNOPSIS Severe burn injury is followed by a profound hypermetabolic response that persists up to 24 months after injury. It is mediated by up to 50-fold elevations in plasma catecholamines, cortisol and inflammatory cells that lead to whole body catabolism, elevated resting energy expenditures and multi-organ dysfunction. All of these metabolic and physiologic derangements prevent full rehabilitation and acclimatization of burn survivors back into society. Modulation of the response by early excision and grafting of burn wounds, thermoregulation, early and continuous enteral feeding with high protein–high carbohydrate feedings and pharmacologic treatments have markedly decreased morbidity.

Toll-Like Receptor Signaling in Burn Wound Healing and Scarring

“…Patients with >40% total body surface area (TBSA) burns whose eschars were excised early showed reductions in circulating cytokines, hypermetabolism, and mortality. 22 In addition, in a mouse study that compared early (day 1) and late (day 8) excision of 8%-TBSA full-thickness burns (without grafting), early excision of the eschar prevented the extreme inflammation and immune dysfunction occurring after late excision (analyzed on day 2 and 6 post eschar excision) that is associated with susceptibility to infection, organ dysfunction, and scarring. 23 In porcine models, early eschar excision accelerated reepithelialization and reduced scarring compared with no excision or delayed excision.…”

“…35 Circulating cytokine levels are altered before the metabolic abnormalities, and larger burns produce greater and more persistent perturbations in circulating inflammatory mediators, immune functions, and stress hormones, as well as more severe catabolism and hypermetabolism to compensate for the evaporative water and heat loss due to the denuded skin. 22 The systemic effects of large burns include increased susceptibility to infection, organ damage and dysfunction, disrupted healing, hypertrophic scarring, and at the extreme end, MODS and mortality (Figs. 4 and 5).…”

Energy expenditure: how much does it matter in infant and pediatric chronic disorders?

“…During the 30-d study period, REE was much lower than expected, and the subjects, who were all exclusively dependent of parenteral nutrition, were at a high risk of overfeeding. On the other hand, children with burn injury have been reported to be hypermetabolic with increased energy expenditure for up to many months after the insult (13). In some chronic illnesses, the impact of energy expenditure on nutritional outcomes is not clear.…”

Energy Metabolism in Burn Injury and Current Approaches to Determine the Energy Requirements

“…Bu faz, mediyatörler aracılığıyla kontrol edilmekte ve metabolik yanıtı düzenleyen katabolik hormonların artması ve anabolik hormonların azalması ile ayırt edilmektedir. [9][10][11][12] "Flow faz"da kalp atım hızı, vücut ısısı, enerji tüketimi, lipoliz, proteoliz ve glukoneogenezde artış gözlenmektedir. Bu reaksiyonlar yara iyileşmesini sağlayan metabolik olayların sonucudur.…”