Lee C. Woodson, Edward R. Sherwood, Asle Aarsland,
Mark Talon, Michael P. Kinsky, and Elise M. Morvant state:
“Increased metabolic rate is the hallmark metabolic alteration that takes place after thermal injury. The size of the burn wound, medical management and the core body temperature of the patient influence the magnitude of hypermetabolism. Within the range of 30–70% TBSA burn injury, hypermetabolism tends to be proportionate to the size of the burn wound. With burns beyond this range, the hypermetabolism appears to plateau and only increases in smaller increments as burn size increases. As mentioned earlier, burn patients increase their metabolic rate in an effort to generate heat according to an increased core temperature threshold set point, which is influenced by the size of the burn.
The recognition of this fact has led to an increased awareness of the importance of the ambient temperature in modulating the hypermetabolism of the burn patient. Resting energy expenditure typically increases as core body temperature decreases below the new set point. Therefore, it is critical to prevent significant decreases in core body temperature in the operating room. As a result of the hypermetabolic response, the burned patient has an increased O2 consumption along with an increased CO2 production that collectively causes increased minute ventilation and demands a higher respiratory effort. The anesthetic care of the acute burned patient must accommodate these changes, and frequently this has to be done in patients with compromised pulmonary function due to burn and inhalation injuries.”
Herndon, David N. "Anesthesia for burned patients" Total Burn Care. Fourth ed. Edinburgh: Saunders Elsevier, 2012. 183. Print.