The effect of staged burn wound closure on the rates of heat production and heat loss of burned children and young adults.

The sequential metabolic studies of nine severely burned patients were examined retrospectively. Information analyzed included heat production (M), partitioned heat loss (HL), the percentage of the body surface area open wound (% open wound) and skin (TS) and rectal (TR) temperatures. The reduction in the hypermetabolic response correlated with the number of days postburn (DPB), % open wound, average body temperature (TB = 0.8TR + 0.2TS) and evaporative heat loss (EV) (r = 0.62, 0.55, 0.56, 0.63, respectively). However, decrements in metabolic rate between sequential studies correlated only with the change in % open wound and the change in EV (r = 0.41 and 0.49, respectively). While changes in heat loss are not capable of predicting all of the variation in metabolic rate, burned patients demonstrate an increase in heat production largely secondary to the inability to conserve heat effectively in the periphery. This response is compounded by an altered central thermoregulation.