 |
|
Influence of Fever on the Hypermetabolic Response in Burn-Injured Children
Dennis C. Gore, MD;
David Chinkes, PhD;
Arthur Sanford, MD;
David W. Hart, MD;
Steven E. Wolf, MD;
David N. Herndon, MD
Arch Surg. 2003;138:169-174.
Background Burn injury typically elicits a hypermetabolic response characterized by increased energy expenditure and muscle protein catabolism.
Hypothesis Fever further increases energy expenditure and muscle loss in otherwise highly hypermetabolic burn patients.
Design Retrospective analysis of experimental study.
Setting University hospital.
Patients Eighty-four children (aged 2-18 years) with burns covering 40% or more of total body surface area.
Interventions None.
Main Outcome Measures Simultaneous measurements of indirect calorimetry and leg net balance of phenylalanine (as an index of muscle protein catabolism) were obtained. Patients were stratified by their rectal temperature taken at the time of these metabolic measurements: afebrile (n = 28; temperature, <39.0°C); mild fever (n = 26; temperature, 39.0°C-39.4°C); moderate fever (n = 18; temperature, 39.5°C-39.9°C); or severe fever (n = 12; temperature,  40.0°C).
Results Febrile and afebrile patients were similar in age, body weight, and extent of burn area. Severe fever was associated with significantly increased resting energy expenditure (mean ± SD resting energy expenditure–predicted basal, 1.38 ± 0.39 for afebrile patients vs 1.68 ± 0.30 for patients with severe fever; P<.05) and a greater net loss of phenylalanine from the leg (net balance of phenylalanine, -6.0 ± 6.2 mg/min per 100 mL of leg volume for afebrile patients vs -10.8 ± 7.2 mg/min per 100 mL for patients with severe fever; P<.05). Patient groups were similar in plasma glucose concentration and extent of leukocytosis.
Conclusions These findings demonstrate the association of severe fever with further increase in energy expenditure and muscle protein catabolism in otherwise hypermetabolic burned children. This suggests a possible metabolic benefit in attenuating fever in such patients.
From the Department of Surgery–Trauma, The University of Texas Medical Branch (Dr Gore) and Shriners Hospitals for Children (Drs Chinkes, Sanford, Hart, Wolf, and Herndon), Galveston.
RELATED ARTICLES
This Month in Archives of Surgery
Arch Surg. 2003;138(2):125.
FULL TEXT
Influence of Fever on the Hypermetabolic Response in Burn-Injured Children—Invited Critique
Mark Silen
Arch Surg. 2003;138(2):174.
EXTRACT
| FULL TEXT
|
