Infectious Diseases Unit, 58878Rambam Health Care Campus, Haifa, Israel.
Technion-Israel Institute of Technology, Haifa, Israel.
J Intensive Care Med. 2021 Aug;36(8):945-953. doi: 10.1177/0885066620940188. Epub 2020 Jul 20.
To assess the effects and safety of β-blockers in hospitalized patients with burns.
A systematic review and meta-analysis of the literature. A broad search was conducted to identify all randomized controlled trials (RCTs) comparing β-blockers to control in hospitalized patients with burns. The primary outcome was 3-month all-cause mortality. Secondary outcomes were clinical patient-relevant end points. We subgrouped results by children/adults and burn severity. Risk of bias was assessed using the individual domain approach.
Four RCTs reported in 11 publications were included. Primary outcome of mortality was assessed in children (2 trials, n = 424) and adults (2 trials, n = 148) with severe burns. No significant difference was found between propranolol and control for mortality (risk ratio [RR] = 0.82, 95% CI = 0.48-1.39, 4 trials with broad confidence intervals in adults and children), sepsis (RR = 0.81, 95% CI = 0.46-1.43, 2 trials), and survivors' length of stay (absolute mean difference = 2.53, 95% CI = -2.58-7.63, 3 trials). There was no significant difference in bradycardia (RR = 1.33, 95% CI = 0.77-2.3, 2 trials), hypotension (RR = 1.26, 95% CI = 0.73-2.17, 3 trials), or cardiac arrhythmia (RR: 2.97, 95% CI: 0.12-71.87, 1 trial). The evidence was graded as very low certainty, due to trial's internal risk of bias, imprecision, and possible selective reporting.
No sufficient evidence was found to support or refute an advantage for β-blocker use in children or adults after burns. Additional studies are needed to create a consensus and formulate practice guidelines on the optimal β-blocker to use, indications for initiation, and duration of treatment.
评估β受体阻滞剂在住院烧伤患者中的疗效和安全性。
系统回顾和文献荟萃分析。广泛检索以确定所有比较β受体阻滞剂与烧伤住院患者对照的随机对照试验（RCT）。主要结局为 3 个月全因死亡率。次要结局为临床相关患者结局。我们根据儿童/成人和烧伤严重程度对结果进行亚组分析。使用个体域方法评估偏倚风险。
纳入了 11 篇文献报道的 4 项 RCT。在严重烧伤的儿童（2 项试验，n=424）和成人（2 项试验，n=148）中评估了死亡率这一主要结局。普萘洛尔与对照组之间的死亡率无显著差异（风险比[RR] = 0.82，95%置信区间[CI] = 0.48-1.39，成人和儿童的试验置信区间较宽），脓毒症（RR = 0.81，95% CI = 0.46-1.43，2 项试验）和幸存者的住院时间（绝对平均差异= 2.53，95% CI = -2.58-7.63，3 项试验）也无显著差异。心动过缓（RR = 1.33，95% CI = 0.77-2.3，2 项试验）、低血压（RR = 1.26，95% CI = 0.73-2.17，3 项试验）或心律失常（RR：2.97，95% CI：0.12-71.87，1 项试验）无显著差异。由于试验内部偏倚风险、不精确性和可能的选择性报告，证据质量被评为极低。
没有足够的证据支持或反驳烧伤后儿童或成人使用β受体阻滞剂的优势。需要开展更多研究，以就最佳β受体阻滞剂的使用、起始适应证和治疗持续时间达成共识并制定实践指南。
