Therapeutic Approaches to Combatting Hypermetabolism in Severe Burn Injuries

Every year, patients with burn injuries account for approximately 500,000 hospital emergency department visits in the United States [1]. While most burn injuries are minor, 40,000 hospitalizations related to severe burn injuries occur annually [1]. Severe burn injuries result in metabolic inflammatory alterations that are similar to those presented by other major trauma patients. However the severity, length, and magnitude of these changes are most profound and prolonged in patients with burn injuries [2-4]. In fact, insulin resistant, hyperglycemic, hypermetabolic state of burn injury patients was found to persist for up to three years [5]. The complex condition of hypermetabolism plays a critical role in the healing and long-term outcomes to severe burn injury in a patient. Burns which encompass greater than 20% total body surface area (TBSA) are characterized by pathophysiological stress, insulin resistance, hyperglycemia and catabolism due to factors such as enhanced glycolysis, proteolysis, lipolysis and wasted substrate cycling [3, 6, 7]. As a result, the clinical complications following severe burn injury are unique and complex [8] and patients require an elaborate and carefully executed treatment plan to combat the challenges they face.