Severe burns over a large portion of a child’s body can speed up normal metabolic processes to alarming levels. This “hypermetabolic” response causes dangerous acceleration in a child’s heart rate and cardiac output, as well as other physiological problems that, unless corrected, can interfere with the body’s ability to use oxygen, glucose and other essential factors. Over time, young patients may experience losses in lean body mass, bone mineral content and density, and nutritional problems that interfere with growth.
The drug propanolol has been shown to decrease cardiac stress in children and to lessen other harmful effects of the hypermetabolic response. However, little was known about how much of the drug was actually needed to lower this pathological stress in young burn patients. Further, nothing was known of how a child’s distinctive physiology may affect drug action within the body, knowledge of which would help guide dosing recommendations.
To establish the correct dosing regimen for this important drug, scientists supported by the Pediatric Trauma and Critical Illness Branch conducted a controlled clinical trial of propanolol in more than 300 pediatric burn patients. Researchers established how much of the drug was necessary to lower pediatric burn patients’ heart rates by 15%, and they determined that the drug acted quickly, achieving effective levels within 30 minutes to 1 hour. The research also found that the dose should be increased significantly over the first 10 days to maintain the benefits of the treatment (PMID: 20598332).