Propranolol Reduces Cardiac Index But does not Adversely Affect Peripheral Perfusion in Severely Burned Children

Abstract

Purpose The aim of this study was to quantify the effect of propranolol on hemodynamic parameters assessed using the PiCCO system in burned children. Methods We analyzed hemodynamic data from patients who were randomized to receive either propranolol (4 mg/kg/day) or placebo (control), which was initiated as a prospective randomized controlled trial. Endpoints were cardiac index (CI), percent predicted heart rate (%HR), mean arterial pressure (MAP), percent predicted stroke volume (%SV), rate pressure product (RPP), cardiac work (CW), systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI), arterial blood gases, events of lactic acidosis, and mortality. Mixed multiple linear regressions were applied, and a 95% level of confidence was assumed. Results One hundred twenty-one burned children (control: N=62, propranolol: N=59) were analyzed. Groups were comparable in demographics, EVLWI, SVRI, %SV, arterial blood gases, Denver 2 post injury organ failure score, incidence of lactic acidosis, or mortality. Percent predicted HR, MAP, CI, CW, and RPP were significantly reduced in the propranolol-treated group (p<0.01). Conclusions Propranolol significantly reduces cardiogenic stress by reducing CI and MAP in children with severe burn injury. Although, peripheral oxygen delivery, events of lactic acidosis, and organ dysfunction was not higher in propranolol treated patients.

Reduced Postburn Hypertrophic Scarring and Improved Physical Recovery With Yearlong Administration of Oxandrolone and Propranolol

“…Based on the hypothesis that elevated catecholamines are responsible for the catabolic phenotype associated with burn injury, 7 research began into the use of propranolol to attenuate postburn hypermetabolism. 8 Since then, the benefits of postburn propranolol has included 9 decreasing myocardial oxygen demand 10 , cardiac work 11–13 , and peripheral lipolysis 12 without increasing the risk of sepsis 14 or exacerbating altered immunity. 15 Similarly, long-term propranolol administration decreased resting energy expenditure, heart rate, and central fat accretion while preventing bone loss and improving lean mass.…”

The P50 Research Center in Perioperative Sciences

“…In burned patients, propranolol reduced tachycardia (26, 53, 54) and the percent predicted heart rate (27), attenuated resting energy expenditure (26, 53, 55), and decreased cardiac work, stress, and output (36). Propranolol also reduces cardiac stress by decreasing cardiac index in burn patients without adversely affecting peripheral perfusion (56). Improvements in body composition were also seen following propranolol administration, with resultant improvements in lean body mass (27), decreased accumulation of central fat (27), and reduced bone loss (27).…”

What's New in Shock, November 2016?

“…It goes against the better judgement of any clinician to give a medication that potentially lowers blood pressure in the patient in the acute phase of an inflammatory response. However, Dr. Wurzer, et al have demonstrated that giving propanolol in burned children is not only safe but potentially helpful (4). The medication reduced cardiogenic stress without adversely affecting other multiple important parameters (4).…”

“…However, Dr. Wurzer, et al have demonstrated that giving propanolol in burned children is not only safe but potentially helpful (4). The medication reduced cardiogenic stress without adversely affecting other multiple important parameters (4). This includes, but is not limited to: peripheral oxygen delivery, events of lactic acidosis, wound healing, and mortality (4).…”

“…The medication reduced cardiogenic stress without adversely affecting other multiple important parameters (4). This includes, but is not limited to: peripheral oxygen delivery, events of lactic acidosis, wound healing, and mortality (4). Clearly, Dr. Wurzer and colleagues are part of a select few investigators with the remarkable ability to see beyond many clinicians’ trepidation to utilize agents such as propanolol in the initial phase of inflammation and shock to help improve outcomes (5, 6).…”