Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review

Viktoria Mertin; Patrick Most; Martin Busch; Stefan Trojan; Christian Tapking; Valentin Haug; Ulrich Kneser; Gabriel Hundeshagen

doi:10.1093/burnst/tkac031

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Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review

更新时间：2023-09-05

- Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review
- Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review
- Burns & Trauma 2022年10卷第1期
- 作者机构：
  
  1. University of Heidelberg
  2. Department of Internal Medicine III University Hospital Heidelberg
  3. Deutsches Zentrum für Herz- und Kreislaufforschung (GCCR)
  4. University of Witten/Herdecke
- 作者简介：
- 基金信息：
- DOI：10.1093/burnst/tkac031
  中图分类号：
- 纸质出版日期：2022，
  
  网络出版日期：2022-9-23，
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Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review[J]. Burns & Trauma, 2022,10(1).

Viktoria Mertin, Patrick Most, Martin Busch, Stefan Trojan, Christian Tapking, Valentin Haug, Ulrich Kneser, Gabriel Hundeshagen, Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review, Burns & Trauma, Volume 10, 2022, tkac031, https://doi.org/10.1093/burnst/tkac031
Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review[J]. Burns & Trauma, 2022,10(1). DOI： 10.1093/burnst/tkac031.

Viktoria Mertin, Patrick Most, Martin Busch, Stefan Trojan, Christian Tapking, Valentin Haug, Ulrich Kneser, Gabriel Hundeshagen, Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review, Burns & Trauma, Volume 10, 2022, tkac031, https://doi.org/10.1093/burnst/tkac031 DOI：

摘要

Abstract

BackgroundIn this systematic review

we summarize the aetiology as well as the current knowledge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options. Severe burn injuries with >20% total body surface area (TBSA) affected commonly leave the patient requiring several surgical procedures

prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase. Particularly in severely burned patients

the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications.MethodsA systematic and protocol-based search for suitable publications was conducted following the PRISMA guidelines. Articles were screened and included if deemed eligible. This encompasses animal-based in vivo studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patientsResultsBoth experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are

nonetheless

lacking in detail. We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems. Lastly

the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized

as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being.ConclusionsThe available in vivo animal models have provided many insights into the interwoven pathophysiology of severe burn injury

especially concerning thermoregulation. We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest and aim to provide an overview of the clinical implications of temperature management in burn patients.

关键词

Keywords

Animal modelBurn shockHypothermiaThermoregulationTemperature managementBurn injuryHypermetabolism

references

1.Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, et al. Recent trends in burn epidemiology worldwide: A systematic review. Burns Mar 2017;43:249–57.

2.Peck MD, Jeschke MG, Collins KA. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. Nov 2011;37:1087–100.

3.Capek KD, Sousse LE, Hundeshagen G, Voigt CD, Suman OE, Finnerty CC, et al. Contemporary Burn Survival. J Am Coll Surg Apr 2018;226:453–63.

4.Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020;6:11.

5.Jeschke MG, Patsouris D, Stanojcic M, Abdullahi A, Rehou S, Pinto R, et al. Pathophysiologic Response to Burns in the Elderly. EBioMedicine 2015;2(10):1536–48.

6.Jeschke MG, Chinkes DL, Finnerty CC, Kulp G, Suman OE, Norbury WB, et al. Pathophysiologic response to severe burn injury. Ann Surg. 2008;248:387–401.

7.Kurz A. Physiology of thermoregulation. Best Pract Res Clin Anaesthesiol. 2008;22:627–44.

8.Wang H, Siemens J. TRP ion channels in thermosensation, thermoregulation and metabolism. Temperature (Austin). 2015;2:178–87.

9.Toussaint J, Singer AJ. The evaluation and management of thermal injuries: 2014 update. Clin Exp Emerg Med. 2014;1:8–18.

10.Pape H-C, Kurtz A, Silbernagel S, eds. Physiologie. vol 9th rev. ed. Stuttgart; New York:Georg Thieme Verlag; 2019:1032.

11.Bräuer A, Perl T, Quintel M. Perioperative thermal management. Anaesthesist. 2006;55:1321–39 quiz 1340. Perioperatives Wärmemanagement.

12.Wilmore DW, Mason AD, Jr, Johnson DW, Pruitt BA, Jr. Effect of ambient temperature on heat production and heat loss in burn patients. J Appl Physiol. 1975;38:593–7.

13.Gowda R, Jaffa M, Badjatia N. Thermoregulation in brain injury. Handb Clin Neurol. 2018;157:789–97.

14.Bautista DM, Siemens J, Glazer JM, Tsuruda PR, Basbaum AI, Stucky CL, et al. The menthol receptor TRPM8 is the principal detector of environmental cold. Nature. 2007;448:204–8.

15.Siemens J, Kamm GB. Cellular populations and thermosensing mechanisms of the hypothalamic thermoregulatory center. Pflugers Arch. 2018;470:809–22.

16.Song K, Wang H, Kamm GB, Pohle J, Reis FC, Heppenstall P, et al. The TRPM2 channel is a hypothalamic heat sensor that limits fever and can drive hypothermia. Science. 2016;353:1393–8.

17.Jeschke MG, Gauglitz GG, Kulp GA, Finnerty CC, Williams FN, Kraft R, et al. Long-term persistance of the pathophysiologic response to severe burn injury. PLoS One. 2011;6:e21245.

18.Porter C, Tompkins RG, Finnerty CC, Sidossis LS, Suman OE, Herndon DN. The metabolic stress response to burn trauma: current understanding and therapies. Lancet. 2016;388:1417–26.

19.Hart DW, Wolf SE, Mlcak R, Chinkes DL, Ramzy PI, Obeng MK, et al. Persistence of muscle catabolism after severe burn. Surgery. 2000;128:312–9.

20.Rutan RL, Herndon DN. Growth delay in postburn pediatric patients. Arch Surg. 1990;125:392–5.

21.Patsouris D, Qi P, Abdullahi A, Stanojcic M, Chen P, Parousis A, et al. Burn Induces Browning of the Subcutaneous White Adipose Tissue in Mice and Humans. Cell Rep. 2015;13:1538–44.

22.Abdullahi A, Samadi O, Auger C, Kanagalingam T, Boehning D, Bi S, et al. Browning of white adipose tissue after a burn injury promotes hepatic steatosis and dysfunction. Cell Death Dis. 2019;10:870.

23.Wang M, Scott SR, Koniaris LG, Zimmers TA. Pathological Responses of Cardiac Mitochondria to Burn Trauma. Int J Mol Sci. 2020;21:6655.

24.Porter C, Herndon DN, Sidossis LS, Børsheim E. The impact of severe burns on skeletal muscle mitochondrial function. Burns. 2013;39:1039–47.

25.Porter C, Herndon DN, Børsheim E, Chao T, Reidy PT, Borack MS, et al. Uncoupled skeletal muscle mitochondria contribute to hypermetabolism in severely burned adults. Am J Physiol Endocrinol Metab. 2014;307:E462–7.

26.Wen JJ, Cummins CB, Williams TP, Radhakrishnan RS. The Genetic Evidence of Burn-Induced Cardiac Mitochondrial Metabolism Dysfunction. Biomedicine. 2020;8:566.

27.Wen JJ, Cummins CB, Szczesny B, Radhakrishnan RS. Cardiac Dysfunction after Burn Injury: Role of the AMPK-SIRT1-PGC1α-NFE2L2-ARE Pathway. J Am Coll Surg. 2020;230:562–71.

28.Wen JJ, Cummins CB, Radhakrishnan RS. Burn-Induced Cardiac Mitochondrial Dysfunction via Interruption of the PDE5A-cGMP-PKG Pathway. Int J Mol Sci. 2020;21:2350.

29.Abdullahi A, Amini-Nik S, Jeschke MG. Animal models in burn research. Cell Mol Life Sci. 2014;71:3241–55.

30.Guillory AN, Clayton RP, Herndon DN, Finnerty CC. Cardiovascular Dysfunction Following Burn Injury: What We Have Learned from Rat and Mouse Models. Int J Mol Sci. 2016;17:53.

31.Campelo AP, Campelo MW, Britto GA, Ayala AP, Guimarães SB, Vasconcelos PR. An optimized animal model for partial and total skin thickness burns studies. Acta Cir Bras. 2011;26:38–42.

32.Porumb V, Trandabăţ AF, Terinte C, Căruntu ID, Porumb-Andrese E, Dimofte MG, et al. Design and Testing of an Experimental Steam-Induced Burn Model in Rats. Biomed Res Int. 2017;2017:9878109.

33.Haugen HA, Chan LN, Li F. Indirect calorimetry: a practical guide for clinicians. Nutr Clin Pract. 2007;22:377–88.

34.Kenny GP, Notley SR, Gagnon D. Direct calorimetry: a brief historical review of its use in the study of human metabolism and thermoregulation. Eur J Appl Physiol. 2017;117:1765–85.

35.Rivas E, McEntire SJ, Herndon DN, Suman OE. Resting β-Adrenergic Blockade Does Not Alter Exercise Thermoregulation in Children With Burn Injury: A Randomized Control Trial. J Burn Care Res. 2018;39:402–12.

36.Rivas E, McEntire SJ, Herndon DN, Mlcak RP, Suman OE. β-Adrenergic blockade does not impair the skin blood flow sensitivity to local heating in burned and nonburned skin under neutral and hot environments in children. Microcirculation. 2017;24:e12350.

37.Hankenson FC, Marx JO, Gordon CJ, David JM. Effects of Rodent Thermoregulation on Animal Models in the Research Environment. Comp Med. 2018;68:425–38.

38.Herndon DN, Wilmore DW, Mason AD, Jr. Development and analysis of a small animal model simulating the human postburn hypermetabolic response. J Surg Res. 1978;25:394–403.

39.Martin CJ, Ferguson JC, Rayner C. Environmental conditions for treatment of burned patients by the exposure method. Burns. 1992;18:273–82.

40.Caldwell FT, Jr, Graves DB, Wallace BH, Moore DB, Crabtree JH. Alteration in temperature regulation induced by burn injury in the rat. J Burn Care Rehabil. 1989;10:486–93.

41.Caldwell FT, Jr, Graves DB, Wallace BH. The response in heat production, plasma catecholamines, and body temperature of burned rats to hypothalamic temperature displacement. J Burn Care Rehabil. 1994;15:315–22.

42.Trop M, Tompkins RG, Schiffrin EJ, Carter EA, Burke JF. Core body temperature responses immediately after cutaneous thermal injury in rats. J Burn Care Rehabil. 1992;13:632–8.

43.Caldwell FT, Jr, Graves DB, Mullis RJ, Wallace BH. The effect of ablation of the preoptic anterior hypothalamus on energy metabolism and plasma catecholamines after burn injury in the rat. J Burn Care Rehabil. 1991;12:446–53.

44.Danilenko DM, Ring BD, Tarpley JE, Morris B, Van GY, Morawiecki A, et al. Growth factors in porcine full and partial thickness burn repair. Differing targets and effects of keratinocyte growth factor, platelet-derived growth factor-BB, epidermal growth factor, and neu differentiation factor. Am J Pathol. 1995;147:1261–77.

45.Shi L, Ermis R, Lam K, Cowart J, Attar P, Aust D. Study on the debridement efficacy of formulated enzymatic wound debriding agents by in vitro assessment using artificial wound eschar and by an in vivo pig model. Wound Repair Regen. 2009;17:853–62.

46.Holliman CJ, Meuleman TR, Larsen KR, Port JD, Stanley TH, Pace NL, et al. The effect of ketanserin, a specific serotonin antagonist, on burn shock hemodynamic parameters in a porcine burn model. J Trauma. 1983;23:867–71.

47.Burmeister DM, McIntyre MK, Baker BA, Rizzo JA, Brown A, Natesan S, et al. Impact of Isolated Burns on Major Organs: A Large Animal Model Characterized. Shock. 2016;46:137–47.

48.Aleksiewicz R, Lutnicki K, Likus M, Gątkiewicz Ł. Effect of TNF-α Concentration on Selected Clinical Parameters of Swine After Burns. J Vet Res. 2018;62:335–40.

49.Jacob S, Zhu Y, Jonkam C, Asmussen S, Traber L, Herndon DN, et al. Effect of bronchodilators on bronchial gland cell proliferation after inhalation and burn injury in sheep. J Burn Care Res. 2013;34:386–93.

50.Prat NJ, Herzig MC, Kreyer S, Montgomery RK, Parida BK, Linden K, et al. Platelet and coagulation function before and after burn and smoke inhalation injury in sheep. J Trauma Acute Care Surg. 2017;83:S59–s65.

51.Sakurai H, Traber LD, Traber DL. Altered systemic organ blood flow after combined injury with burn and smoke inhalation. Shock. 1998;9:369–74.

52.Singer AJ, Taira BR, Thode HC, Jr, McCormack JE, Shapiro M, Aydin A, et al. The association between hypothermia, prehospital cooling, and mortality in burn victims. Acad Emerg Med. 2010;17:456–9.

53.Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108:71–7.

54.Shiozaki T, Kishikawa M, Hiraide A, Shimazu T, Sugimoto H, Yoshioka T, et al. Recovery from postoperative hypothermia predicts survival in extensively burned patients. Am J Surg. 1993;165:326–30 discussion 331.

55.Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997;336:1730–7.

56.Busche MN, Roettger A, Herold C, Vogt PM, Rennekampff HO. Evaporative Water Loss in Superficial to Full Thickness Burns. Ann Plast Surg. 2016;77:401–5.

57.Oda J, Kasai K, Noborio M, Ueyama M, Yukioka T. Hypothermia during burn surgery and postoperative acute lung injury in extensively burned patients. J Trauma. 2009;66:1525–9 discussion 1529-30.

58.Rizzo JA, Rowan MP, Driscoll IR, Chan RK, Chung KK. Perioperative Temperature Management During Burn Care. J Burn Care Res. 2017;38:e277–83.

59.Valeri CR, Feingold H, Cassidy G, Ragno G, Khuri S, Altschule MD. Hypothermia-induced reversible platelet dysfunction. Ann Surg. 1987;205:175–81.

60.Sherren PB, Hussey J, Martin R, Kundishora T, Parker M, Emerson B. Lethal triad in severe burns. Burns. 2014;40:1492–6.

61.Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277:1127–34.

62.Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334:1209–15.

63.Lönnecker S, Schoder V. Hypothermia in patients with burn injuries: influence of prehospital treatment. Chirurg. 2001;72:164–7 Hypothermie bei brandverletzten Patienten--Einflüsse der präklinischen Behandlung.

64.Ziegler B, Kenngott T, Fischer S, Hundeshagen G, Hartmann B, Horter J, et al. Early hypothermia as risk factor in severely burned patients: A retrospective outcome study. Burns. 2019;45:1895–900.

65.Warden GD, Saffle JR, Kravitz M. A two-stage technique for excision and grafting of burn wounds. J Trauma. 1982;22:98–103.

66.Williams FN, Jeschke MG, Chinkes DL, Suman OE, Branski LK, Herndon DN. Modulation of the hypermetabolic response to trauma: temperature, nutrition, and drugs. J Am Coll Surg. 2009;208:489–502.

67.Pruskowski KA, Rizzo JA, Shields BA, Chan RK, Driscoll IR, Rowan MP, et al. A Survey of Temperature Management Practices Among Burn Centers in North America. J Burn Care Res. 2018;39:612–7.

68.Rode H, Brink C, Bester K, Coleman MP, Baisey T, Martinez R. A review of the peri-operative management of paediatric burns: Identifying adverse events. S Afr Med J. 2016;106:1114–9.

69.Trojan S, Limper U, Wappler F. Target Temperature Control in Patients with Burns. Anasthesiol Intensivmed Notfallmed Schmerzther. 2021;56:356–65 Zieltemperaturkontrolle beim Patienten mit Verbrennungen.

70.Bindu B, Bindra A, Rath G. Temperature management under general anesthesia: Compulsion or option. J Anaesthesiol Clin Pharmacol. 2017;33:306–16.

71.Wu X. The safe and efficient use of forced-air warming systems. AORN J. 2013;97:302–8.

72.Williams D, Leslie G, Kyriazis D, O'Donovan B, Bowes J, Dingley J. Use of an Esophageal Heat Exchanger to Maintain Core Temperature during Burn Excisions and to Attenuate Pyrexia on the Burns Intensive Care Unit. Case Rep Anesthesiol. 2016;2016:7306341.

73.Kulstad E, Metzger AK, Courtney DM, Rees J, Shanley P, Matsuura T, et al. Induction, maintenance, and reversal of therapeutic hypothermia with an esophageal heat transfer device. Resuscitation. 2013;84:1619–24.

74.Corallo JP, King B, Pizano LR, Namias N, Schulman CI. Core warming of a burn patient during excision to prevent hypothermia. Burns. 2008;34:418–20.

75.Davis JS, Rodriguez LI, Quintana OD, Varas R, Pizano LR, Namias N, et al. Use of a warming catheter to achieve normothermia in large burns. J Burn Care Res. 2013;34:191–5.

76.Herndon DN, Hart DW, Wolf SE, Chinkes DL, Wolfe RR. Reversal of catabolism by beta-blockade after severe burns. N Engl J Med. 2001;345:1223–9.

77.Breederveld RS, Tuinebreijer WE. Recombinant human growth hormone for treating burns and donor sites. Cochrane Database Syst Rev. 2014;2014:CD008990.

78.Berwin JT, Pearce O, Harries L, Kelly M. Managing polytrauma patients. Injury. 2020;51:2091–6.

79.Madden LK, DeVon HA. A Systematic Review of the Effects of Body Temperature on Outcome After Adult Traumatic Brain Injury. J Neurosci Nurs. 2015;47:190–203.

80.Sidossis LS, Porter C, Saraf MK, Børsheim E, Radhakrishnan RS, Chao T, et al. Browning of Subcutaneous White Adipose Tissue in Humans after Severe Adrenergic Stress. Cell Metab. 2015;22:219–27.

81.Tuvdendorj D, Chinkes DL, Zhang XJ, Suman OE, Aarsland A, Ferrando A, et al. Long-term oxandrolone treatment increases muscle protein net deposition via improving amino acid utilization in pediatric patients 6 months after burn injury. Surgery. 2011;149:645–53.

82.Hart DW, Wolf SE, Ramzy PI, Chinkes DL, Beauford RB, Ferrando AA, et al. Anabolic effects of oxandrolone after severe burn. Ann Surg. 2001;233:556–64.

83.Jeschke MG, Finnerty CC, Suman OE, Kulp G, Mlcak RP, Herndon DN. The effect of oxandrolone on the endocrinologic, inflammatory, and hypermetabolic responses during the acute phase postburn. Ann Surg. 2007;246:351–60 discussion 360-2.

84.Porro LJ, Herndon DN, Rodriguez NA, Jennings K, Klein GL, Mlcak RP, et al. Five-year outcomes after oxandrolone administration in severely burned children: a randomized clinical trial of safety and efficacy. J Am Coll Surg. 2012;214:489–502 discussion 502-4.

85.Williams FN, Herndon DN, Kulp GA, Jeschke MG. Propranolol decreases cardiac work in a dose-dependent manner in severely burned children. Surgery. 2011;149:231–9.

86.Herndon DN, Rodriguez NA, Diaz EC, Hegde S, Jennings K, Mlcak RP, et al. Long-term propranolol use in severely burned pediatric patients: a randomized controlled study. Ann Surg. 2012;256:402–11.

87.Flores O, Stockton K, Roberts JA, Muller MJ, Paratz JD. The efficacy and safety of adrenergic blockade after burn injury: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2016;80:146–55.

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