Pharmacologic Metabolic Modulation in Severe Burn Injury: A Review of the Literature for Oxandrolone and Propranolol

Severe burn injury is associated with a significant hypermetabolic and hypercatabolic response that results in an increase in resting energy expenditure up to twice normal. Consequences of hypermetabolism include lean muscle mass loss and delayed wound healing. Many interventions have been shown to attenuate this metabolic response including early excision and grafting, temperature regulation of the environment, nutrition support, and physical therapy. Pharmacologic agents with proven benefits for metabolic modulation in severe burn injury include oxandrolone, a synthetic testosterone analog, and propranolol, a non-selective beta-adrenergic antagonist. The published literature for these agents will be presented and evaluated in this review, and recommendations for use in patients with severe burn injury will be provided.