The Safety and Efficacy of Propranolol in Reducing the Hypermetabolic Response in the Pediatric Burn Population

Area of Science:

• Pediatric Burn Care
• Cardiovascular Pharmacology
• Hypermetabolic State Management

Background:

• Pediatric burn patients frequently experience long-term hypertension and tachycardia.
• The hypermetabolic state post-burn contributes to these cardiovascular changes.
• Propranolol is recognized for its efficacy in managing the hypermetabolic state.

Purpose of the Study:

• To establish a safe and effective propranolol dosing regimen for pediatric burn patients.
• To evaluate dosing strategies across three distinct age groups (0-3, 4-10, 11-18 years).
• To assess the long-term safety and efficacy of propranolol in managing post-burn cardiovascular sequelae.

Main Methods:

• One hundred four pediatric patients with 30%-92% total body surface area burns received outpatient propranolol treatment for 1-2 years.
• Guardians monitored and documented vital signs (blood pressure, heart rate) daily.
• Dosing was adjusted to achieve a 15%-20% reduction in admission heart rate, guided by age-specific parameters.

Main Results:

• Mean daily propranolol doses were: 5.2 mg/kg/day (0-3 yrs), 4.2 mg/kg/day (4-10 yrs), and 2.9 mg/kg/day (11-18 yrs).
• Dose requirements decreased over time post-burn and were not influenced by burn size or gender.
• Propranolol was safely stopped in some patients without rebound hypertension; no adverse effects were observed.

Conclusions:

• Propranolol is a safe and effective treatment for cardiovascular changes in pediatric burn survivors with a hypermetabolic state.
• Age-specific outpatient dosing regimens are feasible and well-tolerated.
• Older children (>10 years) required lower weight-based doses than younger children.