The effectiveness and safety of beta antagonist in burned patients: A systematic review and meta‐analysis

Abstract

Beta antagonist is one of the most effective and the least toxic pharmacological treatments to attenuate the raised catecholamine effects for burned patients. To evaluate the effectiveness and safety of beta blocker compared with placebo or usual care in burned patients, a meta‐analysis of randomised controlled trials (RCTs) was conducted. We searched the database of PubMed, Embase, the Cochrane Library, and Web of Science to 10 April 2020. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We performed the meta‐analysis using a random‐effect model. A total of 12 RCTs were included in the study, including 1887 patients. Propranolol‐treated patients have a decrease in length of hospital stay in adults (weighted mean difference [WMD] = −9.06, 95% CIs = [−12.88, −5.24]) and prepare time of graft (WMD = −7.88, 95% CIs = [−12.27, −3.50]). Similarly, the use of propranolol could significantly decrease heart rate (WMD = −15.16, 95% CIs = [−20.37, −9.94]), rate pressure product (WMD = −1.32, 95% CIs = [−1.67, −0.97]), and mean arterial pressure (WMD = −2.75, 95% CIs = [−4.23, −1.26]). Moreover, there is no significant difference between propranolol and placebo with respect to mortality (risk difference [RD] = 0.00, 95% CIs [−0.03, 0.04]), sepsis (RD = −0.03, 95% CIs [−0.09, 0.03]), and events of post‐traumatic stress disorder (PTSD) and acute stress disorder (RD = −0.01, 95% CIs [−0.07, 0.05]), and also, there is no significant difference in subgroup analysis based on age. The use of beta antagonist in burned patients does reduce length of hospital stay in adults, shorten the preparation time for graft, and reduce heart burden, without increasing mortality, sepsis, or PTSD compared with those who had usual care or placebo. So beta antagonist can be considered as an appropriate treatment strategy in burned patients. More prospective, randomised‐controlled, multi‐centre studies were needed to define their place in therapeutic algorithms.

Beta-blocker treatment in the critically ill: a systematic review and meta-analysis

“…Two systematic reviews on RCTs in burn patients have recently been published. These reviews also included studies of burn patients under the age of 18 [ 60 , 61 ]. In these systematic reviews there was no significant differences in mortality between the β -blocker and the control groups, but in the individual trials propranolol seemed to improve wound healing.…”

The effect of propranolol on post-accident stress and clinical outcomes of burn patients: a clinical trial

“…Stormer et al (2019) also showed that antihypertensive drugs improve wound healing to some extent (34), which was in line with the results of this study. The administration of propranolol improves wound contraction and causes proper repair of some superficial parts at the border of the deep burn area, thus improving the healing process and reducing graft preparation time (35,36). Avoiding wound infection, reducing catabolism, and maintaining pro-…”

“…A study by MA J et al showed that the use of beta antagonists in burn patients reduces the length of stay in the hospital in adults, shortens the preparation time for transplantation and reduces the burden on the heart, without increasing mortality, and reduces sepsis and PTSD compared to people who received usual care. Therefore, beta antagonist can be considered as a suitable treatment strategy in burn patients (35).…”

“…It should be noted that the amount of reducing the harmful effects of burn injury depends on the dose of propranolol and the duration of use. Therefore, it is safe to treat burn patients with propranolol at doses that reduce the heart rate by 20% of its value at admission and with constant monitoring for side effects (35). Therefore, administering propranolol to patients with severe burns may become a standard of care in the nottoo-distant future.…”