Early manipulation of metabolic changes due to severe burns in children

Burns account for around 700,000 emergency department visits every year resulting in around 50,000 admissions to hospital in the United States [1]. Around 50% of these admissions have burns of less than 10% total body surface area (TBSA) and, as such, have near normal metabolic rates. For the remainder, the rise in metabolic rate is linked to burn size and for those with severe thermal injuries (>40% TBSA) the change in patient metabolism is, if left unchecked, set to last for more than 12 months. The change contributes, at least in part, to long term deleterious effects on the individual. It has been previously shown that the ensuing period of hypermetabolism and catabolism following a severe burn leads to impaired immune function, decreased wound healing, erosion of lean body mass, and hinders rehabilitative efforts delaying reintegration into normal society. However, the magnitude and longevity of these changes has yet to be fully elucidated. Strategies for attenuating these maladaptive responses may be divided into pharmacological and non-pharmacological. Non-pharmacological approaches include prompt, early excision and closure of wounds, pertinacious surveillance for and treatment of sepsis, early commencement of high protein high carbohydrate enteral feeding, elevation of the immediate environmental temperature to 31.5°C (± 0.7°C), and early institution of an aerobic resistive exercise program. Several pharmacotherapeutic options are also available to further reduce metabolic rate and as such attenuate the erosion of lean body mass; these include anabolic agents such as recombinant human growth hormone, insulin, and oxandrolone and also beta blockade using propranolol.