Systematic review of the effect of propanolol on hypermetabolism in burn injuries.

BACKGROUND The use of propranolol has been proposed to reduce the hypermetabolic response of patients with burn injuries. OBJECTIVES To review the studies published up to December 2013 on the effects of propranolol in burn patients. METHODS A PubMed search was conducted using the terms "burns", "thermal injury", "beta-blocker" and "propranolol", with the filters "human" and "English" and "Spanish". A total of 42 citations were retrieved, 15 of which were randomized clinical trials. The main results are summarized. MAIN RESULTS Propranolol at doses adjusted to decrease the heart rate by 20% of the baseline value (4–6 mg/kg/day p.o.) reduces supraphysiological thermogenesis, cardiac work, resting energy expenditure and peripheral lipolysis. It likewise increases the efficiency of muscular protein synthesis and reduces central mass accretion. Most studies have been conducted in pediatric burn patients. CONCLUSIONS Propranolol reduces the hypermetabolic response in pediatric burn patients. More studies on its effects in adult burn patients are needed.