RT Journal
A1 Gore DC, Chinkes D, Sanford A, Hart DW, Wolf SE, Herndon DN
T1 INfluence of fever on the hypermetabolic response in burn-injured children
JF Archives of Surgery
JO Archives of Surgery
YR 2003
FD February 1
VO 138
IS 2
SP 169
OP 174
DO 10.1001/archsurg.138.2.169
UL http://dx.doi.org/10.1001/archsurg.138.2.169
AB Background 
    Burn injury typically elicits a hypermetabolic response characterized by increased energy expenditure and muscle protein catabolism.Hypothesis 
    Fever further increases energy expenditure and muscle loss in otherwise highly hypermetabolic burn patients.Design 
    Retrospective analysis of experimental study.Setting 
    University hospital.Patients 
    Eighty-four children (aged 2-18 years) with burns covering 40% or more of total body surface area.Interventions 
    None.Main Outcome Measures 
    Simultaneous measurements of indirect calorimetry and leg net balance of phenylalanine (as an index of muscle protein catabolism) were obtained. Patients were stratified by their rectal temperature taken at the time of these metabolic measurements: afebrile (n = 28; temperature, <39.0°C); mild fever (n = 26; temperature, 39.0°C-39.4°C); moderate fever (n
= 18; temperature, 39.5°C-39.9°C); or severe fever (n = 12; temperature, ≥40.0°C).Results 
    Febrile and afebrile patients were similar in age, body weight, and extent of burn area. Severe fever was associated with significantly increased resting energy expenditure (mean ± SD resting energy expenditure–predicted basal, 1.38 ± 0.39 for afebrile patients vs 1.68 ± 0.30 for patients with severe fever; P<.05) and a greater net loss of phenylalanine from the leg (net balance of phenylalanine, −6.0 ± 6.2 mg/min per 100 mL of leg volume for afebrile patients vs −10.8 ± 7.2 mg/min per 100 mL for patients with severe fever; P<.05). Patient groups were similar in plasma glucose concentration and extent of leukocytosis.Conclusions 
    These findings demonstrate the association of severe fever with further increase in energy expenditure and muscle protein catabolism in otherwise hypermetabolic burned children. This suggests a possible metabolic benefit in attenuating fever in such patients.