The Hypermetabolic Response to Burns and its Treatment: A Literature Review

Major burn injuries provoke a profound stress response marked by extreme hypermetabolism and impaired immune function. The physiological alterations to glucose, protein and lipid metabolism can be detected even years after the inciting burns injury and when untreated can lead to profound wasting, fatty liver, and even death. Therapeutic strategies which target these physiological disturbances are of paramount importance. Treating burn injuries begins with active cooling, to minimize loss of heat and water, and nutrition, to counteract the extensive catabolism. Providers should follow the strict guidelines published to ensure caloric requirements are met in adult and pediatric patients, with supplementation as indicated. Several pharmacotherapies have proven beneficial in helping to counteract and reverse these physiological changes by lowering insulin resistance, slowing catabolism, and minimizing loss of lean body mass. The most promising drugs include anabolic agents such as insulin, recombinant human growth hormone (rhGH), insulin-like growth factor 1 (IGF-1), metformin, beta-blockers, oxandrolone, and fenofibrate. Surgery is a necessary adjunct, either in the acute phase to debride compromised soft tissue and prevent compartment syndromes, but also in the chronic setting to release contractures and fibrotic strictures which may impair function. This narrative literature review provides a synopsis of our understanding of the hypermetabolic response to burn injury and discusses the different treatment options aiming to control postburn hypermetabolism and ultimately improve patient outcomes.