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Absence of postburn hypermetabolism in a group of children with serious burns
J B Cone1, B H Wallace, F T Caldwell
1University of Arkansas for Medical Sciences, Little Rock.
Insights
Large burn injuries typically cause hypermetabolism, but this study found that a lack of this response did not negatively impact patient survival or recovery. This suggests the hypermetabolic response may not be essential for burn patients.
Area of Science:
- Metabolic response to injury
- Burn patient physiology
Background:
- Hypermetabolism is a common response to large burn injuries, increasing metabolic rate proportionally to wound size.
- This heightened metabolic state persists until wound closure, but its clinical benefit remains unclear.
Purpose of the Study:
- To investigate the clinical significance of hypermetabolism in patients with severe burns.
- To compare outcomes of burn patients who exhibit hypermetabolism versus those who do not.
Main Methods:
- Partitional calorimetry was used to assess metabolic rates in 104 patients with burns covering ≥30% of body surface area.
- Thirteen patients who did not exhibit hypermetabolism were identified and case-matched with hypermetabolic controls.
Main Results:
- The absence of a hypermetabolic response did not correlate with adverse clinical outcomes, including survival, length of hospital stay, or maximum weight loss.
- Five non-hypermetabolic patients demonstrated an appropriate metabolic increase when subjected to cold stress, indicating preserved thermoregulatory function.
Conclusions:
- The hypermetabolic response to severe burn injury may not be essential for patient survival or recovery.
- Further research is needed to fully understand the role and implications of metabolic changes following burn trauma.
Abstract:
Hypermetabolism proportional to wound size is the expected response in patients who sustain large burns. This metabolic response persists until wound closure is achieved. The value of this response to the injured host remains unproven. Between 1978 and 1991, 104 patients with burns covering 30% or more of the body surface area underwent partitional calorimetry as a component of various research protocols. Thirteen of these patients failed to demonstrate an increase in metabolic rate as compared with a control group. These patients without hypermetabolism were compared with case-matched patients who demonstrated the expected increase in metabolic rate. Although they were not hypermetabolic in response to the burn injury, five of these patients were exposed to a cold stress and were able to increase their metabolic rate appropriately. The failure to mount a hypermetabolic response did not impact the clinical course as measured by survival, length of hospital stay, or maximum weight loss.