A survey of the use of propranolol in burn centers: Who, what, when, why

- Propranolol is used in the treatment of burns by the majority of burn centers.
- Adult burn patients are being managed with propranolol based on pediatric data.
- The use of propranolol is variable among burn centers and lacks consensus.
- Indication, dosing and duration of treatment need to be investigated among adults.
- Consensus guidelines for pediatric patients based on current data are needed.

IntroductionMany burn centers utilize propranolol in both adult and pediatric burn patients to attenuate the hypermetabolic response related to thermal injury despite the relative paucity of data in adults compared to children. The purpose of this study was to identify practice patterns related to propranolol, for which groups it is being used, length of use, and the intended benefit.MethodsA 17 question survey regarding the use of propranolol was distributed to burn centers listed in the ABA website with a link to provide anonymous responses.ResultsA 31% response rate was achieved. Results demonstrated 60.5% use propranolol while 39.5% do not. Use in both adult and pediatric patients was reported in 82% of centers. The majority of centers (60.8%) initiate propranolol in patients with >20% TBSA burns. The drug is continued while inpatient for most adults (43%) with only 10% continuing treatment up to 6 months vs. rates of 17.6% long term outpatient use in pediatric patients. Drug dosing ranged from 10 to 40 mg in adults and 0.1 mg/kg to 5 mg/kg in pediatric patients dosed twice daily to four times daily with 25% and 40% titrating the dose to a reduced heart rate respectively. Propranolol was felt to improve outcomes in 56% of responses while 39% were “unsure”.ConclusionThe majority of centers use propranolol for both adult and pediatric patients despise the lack of randomized studies in adult populations. A wide variation of practice patterns highlights the need for further study in regard to patient outcomes, duration of therapy, and dosing to drive consensus guidelines.