The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Mar 1992
Comparative StudyCold stress response in patients with severe burns after beta-blockade.
Adrenergic receptor blockade has been shown to be of benefit in the treatment of adverse cardiovascular changes in patients with burns during the hypermetabolic phase. This article examines the stress response to cold exposure in adults and children with 33% to 95% total body surface area burns with and without beta-blockade. Resting energy expenditures were measured by indirect calorimetry; the test subjects were exposed to mean temperatures of 27.5 degrees C (room temperature) or 24.6 degrees C (cold). ⋯ Data suggest that patients with septic burns already have a maximal metabolic response and that cold stress does not further increase this response. Males, ages 17 to 54 years, were found to increase their resting energy expenditures by 11.4 kcal/m2/day for each percent total body surface area burn. We conclude that beta-blockade with propranolol in therapeutic doses may be used in patients with burns without adversely affecting the cold stress response.
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J Burn Care Rehabil · Mar 1992
Decreasing mortality and morbidity rates after the institution of a statewide burn program.
During the late 1970s, a statewide system for burn treatment and prevention was developed in Maine; it was assumed that such a system would reduce mortality and morbidity rates. To examine the effect of this intervention and the validity of its underlying hypothesis, data for the period from 1973 to 1988 were collected from burn unit registries inside and outside of the state and from hospital discharge abstracts, death certificates, and published sources. In Maine, the annual number of deaths per million persons that resulted from fire- and burn-related injuries declined from 41 in the years 1973-1980 to 25 in the years 1981-1988, which is a significantly greater decrease than for the United States as a whole (p less than 0.001). ⋯ Since a state system was instituted, hospital mortality rates, when grouped by age and burn area, were not significantly different from those reported by the most prominent burn unit in New England. The population-based methods of data collection and linkage that were developed for this investigation may be useful for other studies of injury epidemiology. A statewide burn program appears to have contributed to a reduction in mortality and morbidity rates, primarily through preventive efforts.