Originally created 10/26/01

Drug might help burn patients



BOSTON -- A widely used blood pressure drug shows strong potential for slowing the metabolic overdrive that makes patients waste away after severe burns and other major injuries, researchers say.

The long-recognized phenomenon stems from the body's fight to heal itself. It ramps up metabolic functions and quickens heart rate but ultimately overshoots, eating away muscle and bone and weakening the patient.

Skin grafts can dampen this hypermetabolism in burn patients, but scientists have also tested drugs such as insulin and anabolic steroids. Some show benefit, but none has worked well enough for general use.

In a study in Thursday's New England Journal of Medicine, researchers at Shriners Hospital for Children in Galveston, Texas, tried propranolol on 13 children with bad burns and left 12 untreated to compare.

The drug, one of a class known as beta blockers, checks the stimulating action of the hormone adrenaline and helps keep heart rates down in cardiac patients.

In the Texas experiment, the drug eased the children's heart rates an average of 20 percent. More significantly, the youngsters lost just 1 percent of muscle and bone mass over four weeks of recovery. The untreated group lost 9 percent.

The children all had burns over at least 40 percent of their bodies. None suffered from pneumonia or needed much mechanical help to breathe.

Dr. David Herndon, who led the study, said more research is needed to show how much the preserved body mass strengthens patients and boosts recovery.

But he believes the drug could safely slow hypermetabolism in thousands of patients, including many with crush and broken bone injuries from falls or car wrecks.

He said the drug, pronounced proh-PRAN-ah-lahl, is also inexpensive at roughly $1 a day, compared with perhaps $35 for steroids.

However, it should not be taken by patients with asthma and other respiratory problems, because it aggravates wheezing. Doctors must also be careful not to lower heart rates too far, Herndon said.

Dr. Robert Sheridan, a burn specialist at Massachusetts General Hospital in Boston, said the drug can be used to counter hypermetabolism on some patients now and could ultimately find widespread use. But he recommended other testing on more seriously ill burn patients and others.

On the Net:

New England Journal of Medicine: http://nejm.org

Beta blockers: http://www.encyclopedia.com/articlesnew/01409.html