title: The efficacy and safety of adrenergic blockade after burn injury: A systematic review and meta-analysis.
abstract: BACKGROUND
  The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of the use of adrenergic blockade after burn injury.
  
  
  METHODS
  The databases MEDLINE via OVID, PubMed, EMBASE, CINAHL, Cochrane Library, and Web of Science were searched from inception to December 2014 with search terms including burns and beta-blockers with appropriate synonyms. Articles were restricted to those published in English, French, or Spanish. Randomized controlled trials, nonrandomized controlled trials, and systematic reviews were screened. After an independent screening and full-text review, 10 articles were selected, and an appraisal of risk of bias was performed.
  
  
  RESULTS
  From 182 articles screened, 9 randomized controlled trials and 1 nonrandomized controlled trial met the inclusion criteria. Pooled analyses were performed to calculate effect sizes and 95% confidence intervals (CIs). There was a positive effect favoring propranolol use that significantly decreased resting energy expenditure (g = -0.64; 95% CI, -0.8 to -0.5; p < 0.001) and trunk fat (g = -0.3; 95% CI, -0.4 to -0.1; p < 0.001) as well as improved peripheral lean mass (g = 0.45; 95% CI, 0.3-0.6; p < 0.001) and insulin resistance (g = -1.35; 95% CI, -2.0 to -0.6; p < 0.001). Occurrence of adverse events was not significantly different between the treated patients the and controls.
  
  
  CONCLUSIONS
  Limited evidence suggests beneficial effects of propranolol after burn injury, and its use seems safe. However, further trials on adult population with a broader range of outcome measures are warranted.
  
  
  METHODS
  Systematic review and meta-analysis, level III.
authors.affiliation: From the Burns, Trauma & Critical Care Research Centre (O.F., J.A.R., M.J.M., J.D.P.), School of Medicine, The University of Queensland; Centre for Children's Burns and Trauma Research (K.S.), Queensland Children's Medical Research Institute; Department of Intensive Care Medicine (J.A.R., J.D.P.), Pharmacy Department (J.A.R.), and The Professor Stuart Pegg Adult Burn Service (M.J.M.), Royal Brisbane and Women's Hospital; and Rehabilitation Sciences (J.D.P.), Griffith University, Brisbane, Australia.
authors.forename: Orlando
authors.initials: O
authors.lastname: Flores
authors.forename: Kellie
authors.initials: K
authors.lastname: Stockton
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Muller
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Paratz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D002056:Burns / Q000188:drug therapy* / Q000503:physiopathology*; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology; D006801:Humans; D061214:Patient Safety; D011433:Propranolol / Q000494:pharmacology*
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol