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Propranolol Reduces Cardiac Index But does not Adversely Affect Peripheral Perfusion in Severely Burned Children
Paul Wurzer1, Ludwik K Branski, Robert P Clayton
1*Department of Surgery, University of Texas Medical Branch, Galveston, Texas †Shriners Hospitals for Children-Galveston, Galveston, Texas ‡Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria §Sealy Center for Molecular Medicine and the Institute for Translational Sciences, University of Texas Medical Branch, Galveston, Texas ||School of Medicine, University of Texas Medical Branch, Galveston, Texas ¶Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas.
Insights
Propranolol effectively reduces cardiac stress in burned children by lowering cardiac index and mean arterial pressure. This beta-blocker treatment did not compromise oxygen delivery or increase adverse events like lactic acidosis.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Burn injury management
Background:
- Severe burn injuries in children can lead to significant hemodynamic instability and increased cardiogenic stress.
- Monitoring hemodynamic parameters is crucial for managing critically ill pediatric burn patients.
- Beta-blockers like propranolol are explored for their potential to modulate the hyperdynamic response post-burn.
Purpose of the Study:
- To quantify the impact of propranolol on key hemodynamic parameters in pediatric burn patients.
- To assess the safety and efficacy of propranolol in reducing cardiogenic stress.
- To evaluate the effect of propranolol on oxygen delivery and incidence of adverse events.
Main Methods:
- Prospective randomized controlled trial involving 121 burned children.
- Patients received either propranolol (4 mcg/kg/day) or placebo.
- Hemodynamic parameters (cardiac index, MAP, HR, etc.) were measured using the PiCCO system.
Main Results:
- Propranolol significantly reduced cardiac index (CI), mean arterial pressure (MAP), heart rate (HR), cardiac work (CW), and rate pressure product (RPP) (P < 0.01).
- Groups were comparable in demographics, extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), stroke volume, blood gases, organ failure scores, lactic acidosis, and mortality.
- No significant reduction in peripheral oxygen delivery was observed.
Conclusions:
- Propranolol effectively reduces cardiogenic stress in children with severe burns by decreasing CI and MAP.
- Treatment with propranolol did not lead to reduced peripheral oxygen delivery or increased lactic acidosis or organ dysfunction.
- Propranolol represents a potential therapeutic option for managing cardiogenic stress in pediatric burn patients.
Purpose:
The aim of this study was to quantify the effect of propranolol on hemodynamic parameters assessed using the PiCCO system in burned children.
Methods:
We analyzed hemodynamic data from patients who were randomized to receive either propranolol (4 mg/kg/day) or placebo (control), which was initiated as a prospective randomized controlled trial. Endpoints were cardiac index (CI), percent predicted heart rate (%HR), mean arterial pressure (MAP), percent predicted stroke volume (%SV), rate pressure product (RPP), cardiac work (CW), systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI), arterial blood gases, events of lactic acidosis, and mortality. Mixed multiple linear regressions were applied, and a 95% level of confidence was assumed.
Results:
One hundred twenty-one burned children (control: n = 62, propranolol: n = 59) were analyzed. Groups were comparable in demographics, EVLWI, SVRI, %SV, arterial blood gases, Denver 2 postinjury organ failure score, incidence of lactic acidosis, or mortality. Percent predicted HR, MAP, CI, CW, and RPP were significantly reduced in the propranolol-treated group (P <0.01).
Conclusions:
Propranolol significantly reduces cardiogenic stress by reducing CI and MAP in children with severe burn injury. However, peripheral oxygen delivery was not reduced and events of lactic acidosis as well as organ dysfunction was not higher in propranolol treated patients.
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