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. 2010 Apr;33(4):369-74.
doi: 10.1097/SHK.0b013e3181b92340.

Extent and magnitude of catecholamine surge in pediatric burned patients

Gabriela A Kulp  1 , David N Herndon, Jong O Lee, Oscar E Suman, Marc G Jeschke
Affiliations

Extent and magnitude of catecholamine surge in pediatric burned patients

Gabriela A Kulp et al. Shock. 2010 Apr.

Abstract

Increased catecholamine (CA) levels after severe burn are associated with stress, inflammation, hypermetabolism, and impaired immune function. The CA secretion profiles in burned patients are not well described. Mechanisms, duration, and extent of CA surge are unknown. The purpose of this large unicenter study was to evaluate the extent and magnitude of CA surge after severe burn in pediatric patients. Patients admitted between 1996 and 2008 were enrolled in this study. Twenty-four-hour urine collections were performed during acute hospitalization and up to 2 years postburn. Results from the samples collected from 12 normal, healthy volunteers were compared with the data from the burned patients. Relevant demographic and clinical information was obtained from medical records. Student t-test and one-way ANOVA were used to analyze the data where appropriate. Significance was accepted at P < 0.05. Four hundred thirteen patients were enrolled in this study; 17 patients died during acute hospitalization. Burn caused a marked stress and inflammatory response, indicated by massive tachycardia and elevated proinflammatory cytokines. In burned patients, CA levels are consistently and significantly modulated after burn when compared with the levels in normal, healthy volunteers. Catecholamine levels were significantly higher in boys compared with girls, correlated with burn size in burns greater than 40%, and were increased in older children. There were differences over time in survivors versus nonsurvivors, with CA levels significantly higher in nonsurvivors at two time points. Inflammatory cytokines show a similar profile during the study period. Our study gives clinicians a useful insight into the extent and magnitude of CA elevation to better design treatment strategies.

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Figures

Figure 1
Figure 1
Predicted heart rate according to age during acute hospitalization: burned patients have a significantly increased heart rate compared to norms for age.
Figure 2
Figure 2
Cytokine expression profiles over time in burned children: inflammatory cytokines are increased for a prolonged period of time after burn injury when compared to non-burned children.
Figure 3
Figure 3
Urine CA levels over time in burned patients compared to normal, healthy volunteers: A) Norepinephrine levels are significantly higher in burn patients than in healthy volunteers for up to 2 years post burn. B) Epinephrine levels are higher in burned patients when compared to healthy volunteers for up to 60 days post burn. C) Dopamine levels are lower in burn patients than in healthy volunteers.
Figure 4
Figure 4
Urine CA levels by burn size: there is no identifiable pattern of secretion of CA related to burn size.
Figure 5
Figure 5
Urine CA levels in female vs males: CA levels are significantly higher in males than in females.
Figure 6
Figure 6
Urine CA levels by age: Older patients have higher levels of CA over time.
Figure 7
Figure 7
CA levels in survivors and non-survivors: there is no discernible pattern of CA secretion.
See this image and copyright information in PMC

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