title: Burns: where are we standing with propranolol, oxandrolone, recombinant human growth hormone, and the new incretin analogs?
abstract: OBJECTIVE
  The hypermetabolic response in critically ill patients is characterized by hyperdynamic circulatory, physiologic, catabolic and immune system responses. Failure to satisfy overwhelming energy and protein requirements after, and during critical illness, results in multiorgan dysfunction, increased susceptibility to infection, and death. Attenuation of the hypermetabolic response by various pharmacologic modalities is emerging as an essential component of the management of severe burn patients. This review focuses on the more recent advances in therapeutic strategies to attenuate the hypermetabolic response and its associated insulin resistance postburn.
  
  
  RESULTS
  At present, beta-adrenergic blockade with propranolol represents probably the most efficacious anticatabolic therapy in the treatment of burns. Other pharmacological strategies include growth hormone, insulin-like growth factor, oxandrolone and intensive insulin therapy.
  
  
  CONCLUSIONS
  Novel approaches to the management of critical illness by judicious glucose control and the use of pharmacologic modulators to the hypercatabolic response to critical illness have emerged. Investigation of alternative strategies, including the use of metformin, glucagon-like-peptide-1 and the PPAR-γ agonists are under current investigation.
authors.affiliation: Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany.
authors.forename: Gerd G
authors.initials: GG
authors.lastname: Gauglitz
authors.forename: Felicia N
authors.initials: FN
authors.lastname: Williams
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D045930:Anabolic Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism*; D002056:Burns / Q000378:metabolism* / Q000628:therapy*; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000627:therapeutic use; D010074:Oxandrolone / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use
chemical_list: D045930:Anabolic Agents; D001786:Blood Glucose; D007328:Insulin; D007334:Insulin-Like Growth Factor I; D010074:Oxandrolone; D013006:Growth Hormone; D011433:Propranolol