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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
INTENSIVE CARE SMART 2003 - Milan, may 28-30
Minerva Anestesiologica 2003 April;69(4):264-74
Nutritional and pharmacological support of the metabolic response to injury
Herndon D. N.
Shriners Hospitals for Children-Galveston Burns Hospital, SHC-G Professor of Pediatrics & Surgery, University of Texas Medical Branch, UTMB, USA
Severe burn incites metabolic disturbances which last up to one year post injury. Persistent profound catabolism after severe burn hampers rehabilitative efforts delaying meaningful return of individuals to society. The simplest effective anabolic strategies for severe burn injuries are early excision and grafting of the burn wound, prompt treament of sepsis, maintenance of environmental temperature at 30-32°C, continuous enteral feeding of a high carbohydrate, high protein diet, early institution of vigorous resistive and aerobic resistive exercise programs. To further minimize erosion of lean body mass administration of recombinant human growth hormone, insulin, oxandrolone or propranolol are all reasonable approaches. Exogenous continuous low dose insulin infusion, beta blockade with propranolol and the use of the synthetic testosterone analog, oxandrolone are the most cost effective and least toxic pharmaco therapies to date.