Modulation of the Hypermetabolic Response After Thermal Injury

Abstract

Major thermal injuries have traditionally been associated with mortality and poor outcomes. Over the past three decades, however, patient survival has improved due to greater understanding of the hypermetabolic stress response and advancements in burn care treatment. The hypermetabolic response is not only an acute phenomenon, but continues for at least 9-12 months post-injury. Circulating levels of glucagon, cortisol and catecholamines are increased leading to a catabolic state that results in loss of lean body mass and muscle wasting. An important intervention after a burn injury is attenuation of the catabolic activity occurring. Non-pharmacological interventions include early excision and grafting, control of infection, sustaining room temperatures to an ambient level of 33ºC, and instituting a high carbohydrate enteral diet early in the acute setting. Pharmacological alternatives include the use of recombinant human growth hormone, insulin-like growth factor-1, insulin, oxandralone, and propranolol. The purpose of this paper is to review the mechanisms of the hypermetabolic response and the current modes of treatment to provide optimal care and improved outcomes for the severely burned patient.