Objective:
Severe burn injuries are associated with a rapid escalating hypermetabolic state and catabolism of muscle mass. To ameliorate this process a standardized approach using pharmacological and non-pharmacological interventions was implemented within a single burns center. Whilst individual components of this standardized package are well documented in the literature, their collective or bundled effect has not as yet been assessed. The aim of this study was to evaluate the efficacy of this standardized bundle of metabolic modulators and assess the safety of including the anabolic steroid oxandrolone within it.
Methods:
This retrospective observational study constituted all patients in whom the metabolic bundle including oxandrolone therapy was applied. The other elements of the metabolic bundle consisted of early surgical burn excision within seven days to completion, early active mobilization, increased ambient room temperature, expediated carbohydrate and protein rich enteral feeding with glutamine and trace element supplements (such as copper and zinc). Finally, administration of propranolol as a non-selective beta-blocker.
Data collection was through review of the patient data management system focusing on the outcome criteria and hepatic blood values.
Results:
The study looked at fifty consecutive patients meeting the inclusion criteria. Median patient age and burned total body surface area (TBSA) were 62 years [51.75; 73] and 33.75 % [24.75; 51] respectively with an abbreviated burn severity index (ABSI) of 10 [9; 10.25]. Definitive surgical burn wound excision was completed in 44 patients [88 %] within 7 days. 39 patients (78 %) received propranolol over a therapeutic period of 29 days [19; 44].
Glutamine was supplemented in 45 patients (90 %), while zinc and copper were applied to 42 (84 %) and 31 (62 %) respectively. Significant low zinc values were noted at therapeutic onset (6.5 mmol/ l [4.7; 7.9]) requiring sustained substitution over 37.5 days [22; 46.75]).
In respect of the inclusion criteria, all patients received oxandrolone at 20mg/day [20; 20]. This was commenced on day 6.5 [4; 14] post burn injury and continued over 26 days [19; 31]. Despite a transitory elevation of hepatic enzyme values (ALT, GGT), these were only clinically relevant (>10µmol/l*S) in 2.4 % and 4.6 % of all measurements respectively. None were sufficiently of concern to merit cessation of treatment.
Conclusion:
The application of a standardised bundle of metabolic treatment options of severe burns injured patients is reliable, repeatable and safe. Potential concerns of oxandrolone treatment regarding hepatic compromise remain unfounded.:Introduction
Epidemiology of severe burns injuries in the Federal Republic of Germany
The hypermetabolic and catabolic state
Therapeutic approach
Non-pharmacological therapy
Early surgical intervention
Ambient temperature
Enteral feeding in burns patients
Occupational and physiotherapy in burns patients
Pharmacological therapy
Insulin
Propranolol
Oxandrolone
Oxandrolone in the Federal Republic of Germany
Metabolic bundle
Materials and Methods
Subjects and study design
Ethical approval
Burn care protocol
Oxandrolone and the metabolic bundle
Data collection
Statistical analysis
Objective of study
Publication
Summary
References
Appendix
Declaration of independent scientific contribution, conception and execution of publication
Declaration of independent scientific contribution towards dissertation
Curriculum vitae
Acknowledgements and thanks
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:75491 |
| Date | 22 July 2021 |
| Creators | Taha, Hischam |
| Contributors | Universität Leipzig |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/acceptedVersion, doc-type:doctoralThesis, info:eu-repo/semantics/doctoralThesis, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
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