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The efficacy and safety of adrenergic blockade after burn injury: A systematic review and meta-analysis

Flores, Orlando PT; Stockton, Kellie PhD; Roberts, Jason A. PhD; Muller, Michael J. MMedSc; Paratz, Jennifer D. PhD

Journal of Trauma and Acute Care Surgery: January 2016 - Volume 80 - Issue 1 - p 146–155
doi: 10.1097/TA.0000000000000887
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BACKGROUND The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of the use of adrenergic blockade after burn injury.

METHODS The databases MEDLINE via OVID, PubMed, EMBASE, CINAHL, Cochrane Library, and Web of Science were searched from inception to December 2014 with search terms including burns and beta-blockers with appropriate synonyms. Articles were restricted to those published in English, French, or Spanish. Randomized controlled trials, nonrandomized controlled trials, and systematic reviews were screened. After an independent screening and full-text review, 10 articles were selected, and an appraisal of risk of bias was performed.

RESULTS From 182 articles screened, 9 randomized controlled trials and 1 nonrandomized controlled trial met the inclusion criteria. Pooled analyses were performed to calculate effect sizes and 95% confidence intervals (CIs). There was a positive effect favoring propranolol use that significantly decreased resting energy expenditure (g = −0.64; 95% CI, −0.8 to −0.5; p < 0.001) and trunk fat (g = −0.3; 95% CI, −0.4 to −0.1; p < 0.001) as well as improved peripheral lean mass (g = 0.45; 95% CI, 0.3–0.6; p < 0.001) and insulin resistance (g = −1.35; 95% CI, −2.0 to −0.6; p < 0.001). Occurrence of adverse events was not significantly different between the treated patients the and controls.

CONCLUSION Limited evidence suggests beneficial effects of propranolol after burn injury, and its use seems safe. However, further trials on adult population with a broader range of outcome measures are warranted.

LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.

Supplemental digital content is available in the text.

From the Burns, Trauma & Critical Care Research Centre (O.F., J.A.R., M.J.M., J.D.P.), School of Medicine, The University of Queensland; Centre for Children’s Burns and Trauma Research (K.S.), Queensland Children’s Medical Research Institute; Department of Intensive Care Medicine (J.A.R., J.D.P.), Pharmacy Department (J.A.R.), and The Professor Stuart Pegg Adult Burn Service (M.J.M.), Royal Brisbane and Women’s Hospital; and Rehabilitation Sciences (J.D.P.), Griffith University, Brisbane, Australia.

Submitted: March 13, 2015, Revised: August 11, 2015, Accepted: September 2, 2015, Published online: October 29, 2015.

Registered at PROSPERO. Registration number CRD42014015115.

No reprints will be ordered.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Orlando Flores, PT, Burns, Trauma & Critical Care Research Centre, Level 7, Block 6 Bldg, Royal Brisbane and Women’s Hospital, Herston QLD. Brisbane, Australia 4029; email: orlando.flores.g@uqconnect.edu.au.

© 2016 Lippincott Williams & Wilkins, Inc.