Post burn muscle wasting and the effects of treatments

Severe burns are typically followed by a hypermetabolic response that lasts for at least 9–12 months post-injury. The endocrine status is also markedly altered with an initial and then sustained increase in proinflammatory ‘stress’ hormones such as cortisol and other glucocorticoids, and catecholamines including epinephrine and norepinephrine by the adrenal medulla and cortex. These hormones exert catabolic effects leading to muscle wasting, the intensity of which depends upon the percentage of total body surface area (TBSA) involved, as well as the time elapsed since initial injury. Pharmacological and non-pharmacological strategies may be used to reverse the catabolic effect of thermal injury. Non-pharmacological strategies include early excision and wound closure of burn wound, aggressive treatment of sepsis, elevation of the environmental temperature to thermal neutrality (31.5 ± 0.7 °C), high carbohydrate, high protein continuous enteral feeding and early institution of resistive exercise programs. Pharmacological modulators of the post-burn hypermetabolic response may be achieved through the administration of recombinant human growth hormone, low dose insulin infusion, use of the synthetic testosterone analogue, oxandrolone and beta blockade with propranolol. This paper aims to review the current understanding of post-burn muscle proteolysis and the effects of clinical and pharmacological strategies currently being studied to reverse it curb these debilitating sequelae of severe burns.