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A survey of the use of propranolol in burn centers: Who, what, when, why
Michael Thomas LeCompte1, Lisa Rae2, Steven Alexander Kahn3
1Vanderbilt University Medical Center 1121 Medical Center Drive Nashville, TN 37232-7175, USA.
Insights
Most burn centers use propranolol for adults and children to manage hypermetabolism, despite limited adult data. Practice variations in dosing and duration highlight the need for further research and guidelines.
Area of Science:
- Burn Care
- Pharmacology
- Critical Care Medicine
Background:
- Propranolol is frequently used in burn centers for adult and pediatric patients to mitigate hypermetabolic responses post-thermal injury.
- Current clinical practice often outpaces the available evidence, particularly in adult burn populations.
Purpose of the Study:
- To survey current practice patterns regarding propranolol use in burn centers.
- To identify patient populations, duration of therapy, and perceived benefits of propranolol.
Main Methods:
- A 17-question anonymous survey was distributed to burn centers listed on the American Burn Association (ABA) website.
- A 31% response rate was achieved from participating centers.
Main Results:
- 60.5% of responding centers utilize propranolol, primarily in patients with burns exceeding 20% Total Body Surface Area (TBSA).
- While commonly continued inpatient for adults, long-term outpatient use is more prevalent in pediatric patients.
- Perceived benefits were reported by 56%, with 39% unsure of the drug's impact.
Conclusions:
- Propranolol is widely adopted for both adult and pediatric burn patients, contrasting with a lack of robust adult studies.
- Significant variability in practice patterns for propranolol dosing, duration, and patient selection necessitates further investigation.
- Evidence-based guidelines are needed to standardize propranolol therapy and improve patient outcomes in burn care.
Introduction:
Many burn centers utilize propranolol in both adult and pediatric burn patients to attenuate the hypermetabolic response related to thermal injury despite the relative paucity of data in adults compared to children. The purpose of this study was to identify practice patterns related to propranolol, for which groups it is being used, length of use, and the intended benefit.
Methods:
A 17 question survey regarding the use of propranolol was distributed to burn centers listed in the ABA website with a link to provide anonymous responses.
Results:
A 31% response rate was achieved. Results demonstrated 60.5% use propranolol while 39.5% do not. Use in both adult and pediatric patients was reported in 82% of centers. The majority of centers (60.8%) initiate propranolol in patients with >20% TBSA burns. The drug is continued while inpatient for most adults (43%) with only 10% continuing treatment up to 6 months vs. rates of 17.6% long term outpatient use in pediatric patients. Drug dosing ranged from 10 to 40mg in adults and 0.1mg/kg to 5mg/kg in pediatric patients dosed twice daily to four times daily with 25% and 40% titrating the dose to a reduced heart rate respectively. Propranolol was felt to improve outcomes in 56% of responses while 39% were "unsure".
Conclusion:
The majority of centers use propranolol for both adult and pediatric patients despise the lack of randomized studies in adult populations. A wide variation of practice patterns highlights the need for further study in regard to patient outcomes, duration of therapy, and dosing to drive consensus guidelines.
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