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Prolonged use of propranolol safely decreases cardiac work in burned children
P W Baron1, R E Barrow, E J Pierre
1Shriners Burn Institute, The University of Texas Medical Branch, Galveston 77550-2725, USA.
Insights
Propranolol effectively and safely reduces heart rate and cardiac work in severely burned children for up to 10 days. This beta-blocker treatment is well-tolerated, showing no adverse effects in pediatric burn patients.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular pharmacology
- Burn management
Background:
- Massively burned children experience increased heart rate and cardiac workload.
- Propranolol has demonstrated efficacy for short-term (5 days) cardiac support in this population.
- Extended use of propranolol beyond 5 days in pediatric burn patients requires further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of propranolol for 10 days in reducing heart rate and cardiac work in severely burned children.
- To assess the sustained effects of propranolol on cardiovascular parameters and biochemical markers.
- To determine the optimal route of administration (oral vs. intravenous) for propranolol in this patient group.
Main Methods:
- Prospective study of 22 children (1-10 years) with burns covering >= 40% total body surface area.
- Treatment with oral or intravenous propranolol (0.5-1.0 mg/kg every 8 hours) for 10 days.
- Monitoring of heart rate, rate-pressure product, mean arterial blood pressure, and laboratory values (urea nitrogen, creatinine, glucose).
Main Results:
- Propranolol significantly decreased mean daily heart rate (10-13%) and rate-pressure product (10-16%) in both septic and nonseptic patients (p < 0.05).
- No significant changes were observed in mean arterial blood pressure or plasma urea nitrogen, creatinine, or glucose levels.
- No adverse events such as hypotension, hypothermia, arrhythmia, or bronchospasm were reported during or after treatment.
Conclusions:
- Propranolol can be safely and effectively administered for 10 days to decrease cardiac workload in severely burned children.
- Both oral and intravenous routes of propranolol administration were found to be safe and effective.
- Extended propranolol therapy is a viable option for managing cardiovascular stress in pediatric burn patients.
Abstract:
Propranolol has been shown to be effective for as long as 5 days in massively burned children to reduce heart rate and cardiac work. This article describes the use of propranolol given for 10 days to burned children to test whether the drug remains effective and safe in reducing heart rate and cardiac work for longer periods. We prospectively studied 22 children, 1 to 10 years of age with burns covering > or = 40% of their total body surface area. These children were treated with 0.5 to 1.0 mg/kg propranolol given orally or intravenously every 8 hours for 10 days. In both septic and nonseptic patients, propranolol significantly decreased their daily average heart rate (between 10% and 13%, p < 0.05) and rate-pressure product (between 10% and 16%, p < 0.05) compared with their 24-hour mean before propranolol treatment. No significant change in mean arterial blood pressure, or plasma urea nitrogen creatinine or glucose levels could be shown. No hypotension, hypothermia, azotemia, hyperglycemia or hypoglycemia, arrhythmia, bronchospasm, or peripheral ischemia was noted during or after treatment. Whereas propranolol lowered heart rate more per milligram per kilogram body weight when given intravenously, both routes were safe and effective. From these data, we conclude that propranolol can be given to decrease the work of the heart safely and effectively for > or = 10 days.