Modulation of hypermetabolism in burn patient by administration of propranolol in the first two weeks and assessing its effect by using clinical and biochemical parameters

Abstract

Background: India being a developing country has a high incidence of thermal injuries. Severe burn injury is followed by a state of hypermetabolism, which causes increased cardiac workload and increased resting energy expenditure causing muscle wasting, leading to increased morbidity. The aim of this study is to test the effect of propranolol in modulating the state of hypermetabolism in the acute postburn phase using various clinical and laboratory parameters. Materials and Methods: This is a prospective case-control study which includes 50 cases of thermal injuries with total burn surface area 20-60% conducted at burn unit of a Tertiary Care Center over a period of 1-year. The patients were divided into test (propanolol) and control groups. Similar burn treatment was continued in both groups and change in the laboratory, and clinical parameters were noted. Results were compared within the groups using paired t-test and in between the groups using unpaired t-test. Result: This study shows a significant reduction of 20% in the heart rate and 28% in the sleeping pulse rate with 2 weeks of propranolol therapy (P < 0.0001). There was a 2.5% increase in the weight along with 6% increase in mid-arm circumference. There was a 5% increase in total serum albumin concentration and resolution of pedal edema by the end of 2 weeks of therapy. C-reactive protein was found to be reduced by 10% (P < 0.0001). Conclusion: The results prove propranolol as an effective modulator of hypermetabolism by counteracting the effect of catecholamine, reducing infection and inflammation hence improving the overall outcome of severe burn patients.