Main characteristics from included studies were summarized in Additional file 2: Appendix 1. Losses to follow-up were reported in four trials, and finally, an intention-to-treat analysis was performed in two trials.
TO HEART 2 KOMAK TRIAL
Of the ten RCTs included, nine recruited participants from the USA and one trial recruited patients from Iran. Five trials (50%) were single-center trials. These trials randomized a total of 1236 participants with a sample size ranging from 25 to 406 (median, 76 interquartile range, 58.5–195.5). Included trials were published between 20. For the interpretation, it was determined that the values of 25, 50, and 75% in the I 2 test corresponded to low, medium, and high levels of heterogeneity, respectively. Heterogeneity was evaluated using the I 2 test. Meta-analysis was considered since the included studies were similar in terms of participants, interventions, and outcomes (clinical homogeneity). The results were reported in forest plots of the estimated effects of the included studies with a 95% confidence interval (95% CI). Mean differences (MD) and risk differences were pooled using a random-effects model. Whenever possible, we used results from an intention-to-treat population. For continuous outcomes, we extracted end-value means with standard deviations (SD). For dichotomous outcomes, we extracted data on the total number of participants, the number that experienced the outcomes, and the number analyzed. The statistical analysis was performed using Review Manager 5.3 (RevMan® 5.3). The objective of this systematic review was to determine the effectiveness and safety of propranolol compared to placebo or usual care for improving clinical relevant outcomes in severely burned patients (TBSA >20%).Ī meta-analysis was performed to assess the overall outcomes of propranolol compared to usual care or placebo. Propranolol through β-adrenergic receptor blockade has been proposed as an effective strategy for reducing post-burn catabolism and therefore to improve outcomes in burned patients. Several interventions have been proposed to decrease the hypermetabolic response and to improve outcomes in the burned patient. The hypermetabolic response along with catecholamines and corticosteroids increase liver and cardiac work, impair muscle function, increase the risk of sepsis, and produce hormonal abnormalities that augment morbidity and mortality. Injuries greater than this percentage invariably results in severe impairments of cardiovascular, respiratory, metabolic, and immunological functions derived from hypermetabolic changes. The release of cytokines and other pro-inflammatory mediators at the site of injury has a systemic effect once the burn reaches 20% of total body surface area. The chronic “flow” phase is a critical phase that requires medical intervention to reduce the risk of fatal outcomes. The ebb phase, occurring within the first 48 h after injury, is associated with decreased cardiac output, oxygen consumption, and metabolic rate. Hypermetabolic state has two aspects-the “ebb” and “flow” phases. īurn injuries covering more than 20% of the total body surface area (TBSA) cause an inflammatory and subsequent hypermetabolic response that starts immediately post-burn and can persist for years. The incidence of burns in low- and middle-income countries is 1.3 per 100,000 population whereas in high-income countries is approximately of 0.14 per 100,000 population with burn injuries ranking the top 15 leading causes of burden of disease globally. For adults, the incidence of burns is low until the 30s, with cases occurring at home, outdoors, and at workplaces in equal proportions.
Episodes occur commonly at home and principally due to scalds, hot objects, and fires. Burns are a common cause of morbidity and mortality, and most occur in a domestic setting with children from birth through 4 years having the highest burden of the condition. Burn injuries are among the most severe of all injuries with approximately 90% of cases occurring in low- and middle-income countries.
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