Do β-Blockers Decrease the Hypermetabolic State in Critically Ill Children With Severe Burns?

BACKGROUND AND OBJECTIVES Severe burns result in a hypermetabolic state that is associated with increased morbidity and mortality. We reviewed the literature to determine if there is strong evidence that short-term β-blockers reduce the hypermetabolic state or mortality and length of stay (LOS) compared with no therapy in patients with severe burns. METHODS A literature search of PubMed, Embase, the Cochrane Database of Systematic Reviews, and BestBETs was conducted on the use of adrenergic β-antagonists in burn patients. RESULTS Six randomized controlled trials met the inclusion criteria. Five pediatric trials found that β-blockers reduced the hypermetabolic state (as defined by reduction of cardiac work, rate pressure product, resting energy expenditure, central deposition of fat, and bone mineral loss) and were associated with an improvement in lean muscle mass in patients with severe burns. However, there was no change in LOS or mortality in these children. One adult study in burn patients found shorter LOS in patients treated with β-blockers but no difference in mortality rate. β-blockers were relatively well tolerated, with no differences in adverse effects reported. CONCLUSIONS β-blockers seem to reduce the hypermetabolic state in pediatric patients with burns, but there is insufficient evidence to suggest they have an impact on mortality rates or LOS.