The Relative Significance of Thermal and Metabolic Demands on Burn Hypermetabolism

Lh, Aulick; Eh, Hander; Dw, Wilmore; Ad, Mason; Ba, Pruitt

doi:10.1097/00005373-197908000-00003

Cited by 47 publications

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“…Although postburn hypermetabolism was ameliorated to some extent by letting patients equilibrate at the elevated thermoneutral temperature (around 30 to 33°C) associated with large burns, Wilmore and his associates 1327 - 28 reported that the mean metabolic rate of burn patients at environmental temperatures from 21 to 33°C was never as low as that of unburned controls. In these studies, core temperatures of burn patients remained above those for controls at all environmental temperatures employed.…”

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confidence: 99%

“…The postburn elevation in metabolic rate also is not driven by hyperthermia because in burn patients (including those treated by reduction of heat loss 29 and delivery of an extra heat load by heat lamps 2830 ) metabolic rate is greatly in excess of that explainable by a supposed Q 10 of 2 (see Chapter 14), and an extra heat load does not further raise the metabolic rate even though body temperature may rise. 28 Postburn hypermetabolism apparently results from a resetting of the thermogenic control for heat production and core temperature at levels (dependent on burn size) higher than normal. Injury hypermetabolism thus is temperature-sensitive but is not temperature-dependent.…”

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confidence: 99%

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Neuroendocrine and Sympathoadrenal Response to Thermal Trauma

Vaughan¹

1990

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The previous chapters have described many alterations in secreted hormones and metabolic processes that occur for weeks to months after major burn injury. Interpretation of these alterations can be bewildering; however, many of the findings can be simplified and/or unified to a certain extent if they are viewed as part of an overall alteration in central nervous system (CNS) function characterized by modified control settings. The Neuroendocrine Reflex ArcEarly work with acute surgical trauma provided the conceptual framework of the neuroendocrine reflex arc. 12 In this framework, a signal from an injured area is transmitted by an afferent limb to the brain, which integrates the formation and orchestrates a neural and hormonal output as the efferent limb.Hume and Egdahl 3 studied dogs anesthetized with ether or Nembutal and with a catheter in an adrenal vein. Upon application of a scald burn, the corticosteroid (CS) secretion rate rose promptly within minutes. This response was blocked by prior section of the medulla oblongata, the spinal cord, or the peripheral nerve innervating the area of the lesion. Subcutaneous injection of ACTH in the denervated burned area provoked a CS response, indicating that if a burn toxin were present and capable of stimulating this acute response humorally, it would likely have been detected. Thus, the acute CS response to a burn did not result from pain per se, which was blocked by the anesthesia, nor from systemic absorption of a humoral toxin from the burned area, but from afferent neural information signaling the presence of an injury. In some experiments, crude measurements of circulating ACTH indicated that the CS response was associated with a surge in endogenous ACTH release. Lesions of the anterior hypothalamus blocked the CS and ACTH responses to operative trauma. These and the cord section experiments indicated that the adrenocortical response was via brain control of ACTH secretion, not via innervation of the adrenals. Nevertheless, activation of the adrenal medullae through the neural route was indicated by observation of elevated catecholamine (CA) secretion rates in the adrenal vein after injury.

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Section: Distribution Statement a Approved For Public Release Distribmentioning

confidence: 99%

Section: Distribution Statement a Approved For Public Release Distribmentioning

confidence: 99%

Neuroendocrine and Sympathoadrenal Response to Thermal Trauma

Vaughan¹

1990

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“…The problem with this concept was that postburn hypermetabolism could not be eliminated by either blocking wound evaporation or raising ambient temperature into the thermoneutral zone (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Effects of Wound Bacteria on Postburn Energy Metabolism

Aulick¹

1990

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“…The energy expenditure at this time sometimes rises to three times the normal level (120 W m-2). Hypermetabolism may be primarily an attempt by the body to compensate for the increased evaporative heat losses (Harrison et al, 1964;Barr et al, 1968 ;Henane et al, 1981), although hormone imbalance, and factors related to tissue repair are also important (Wilmore et al, 1974;Aulick et al, 1979). If a high metabolic rate is maintained, this will deplete the body's energy store.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Environmental Factors on Evaporation and Heat Loss from Burned Tissue

Martin

Muir

1985

Engineering in Medicine

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Destruction of skin by severe burning leads to substantial loss of fluid. Increased evaporative heat loss in addition to energy demands for tissue repair causes hypermetabolism in a severely burned patient, placing a large stress on the body. The dependence of evaporation rate and energy supply on environmental variables has been studied using a phantom in which a free water surface simulated burned tissue. Vapour diffusion resistances have been derived from the experiments, and compared with values calculated from data obtained from other studies of burned tissue. These can be used to predict rates of evaporation and heat loss for burned tissue, and their dependence on different environmental factors. Experiments have shown that energy in the form of radiant heat or warm air blown over the water surface can be supplied to reduce heat losses without significantly affecting evaporation rate.

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The Relative Significance of Thermal and Metabolic Demands on Burn Hypermetabolism

Cited by 47 publications

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Neuroendocrine and Sympathoadrenal Response to Thermal Trauma

Neuroendocrine and Sympathoadrenal Response to Thermal Trauma

Effects of Wound Bacteria on Postburn Energy Metabolism

The Influence of Environmental Factors on Evaporation and Heat Loss from Burned Tissue

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