Estimación de factores de riesgo del retardo en la cicatrización en pacientes quemados / Estimation of Risk Factors for Delayed Healing in Burn Patients

Introducción: La atención al paciente con retardo en la cicatrización parte de la optimización en sus cuidados. La reversión del cuadro requiere del conocimiento de los factores de riesgo. La literatura nacional e internacional describen factores locales o relacionados con la herida y generales o relacionados al estado general del paciente. Objetivo: Estimar los factores de riesgo del retardo en la cicatrización en pacientes quemados. Métodos: Estudio analítico de casos y control en pacientes quemados ingresados en el Servicio de Caumatología del Hospital Universitario Manuel Ascunce Domenech en el período 2017 a 2021. La población objeto de estudio comprendió a 267 pacientes. Se calculó el odds ratio y el intervalo de confianza. Resultados: El desarrollo de retardo en la cicatrización resultó tres veces y media más probable en pacientes quemados con 45 años y más, odds ratio 3,591. Además, fue nueve veces más probable en enfermedades crónicas asociadas, hasta seis veces en quemaduras no accidentales, 163 veces en la complicación local y 89 veces en la complicación sistémica. Conclusiones: Los factores de riesgo del retardo en la cicatrización en pacientes quemados identificados fueron los siguientes: edad de 45 años y más, presencia de comorbilidad, el fuego directo como agente causal, el modo de producción no accidental, la presencia de más de seis zonas anatómicas afectadas, la quemadura hipodérmica, la quemadura de 20 porciento de superficie corporal quemada y más de extensión, el apoyo de la lesión, el índice cubano de pronóstico con riesgo vital, la complicación local y la complicación sistémica(AU)

Introduction: The care for the patient with delayed healing starts from the optimization of their care. Reversing such condition requires knowledge of the risk factors. The national and international literature describes local factors related to the injury and general factors related to the patient's general condition. Objective: To estimate the risk factors for delayed healing in burn patients. Methods: An analytical case-control study was carried out with burn patients admitted to the caumatology service at Hospital Universitario Manuel Ascunce Domenech in the period from 2017 to 2021. The study population consisted of 267 patients. Odds ratio and confidence interval were calculated. Results: The development of delayed healing was three and a half times more likely in burn patients aged 45 years or over (odds ratio: 3.591). In addition, it was nine times more likely for associated chronic diseases, up to six times in nonaccidental burns, 163 times in local complications, and 89 times in systemic complications. Conclusions: The identified risk factors for delayed healing in burn patients were the following: age 45 years or over, presence of comorbidity, direct fire as causative agent, nonaccidental way of production, presence of more than six affected anatomical areas, hypodermic burn, burn extension of 20 percent or over on the burned body surface, injury contact pressure, the Cuban index of prognostic vital risk, as well as the local or the systemic complications(AU)

National multicentric study on the incidence of alcohol burns during the COVID-19 pandemic.

BACKGROUND: Burns are traumatic wounds that occur when skin is exposed to an amount of energy greater than its maximum dissipation capacity. Alcohol, because it fuels flames and its vapor can cause an explosion, is one of the most common causal agents of burns in Brazil. In late 2019, the COVID-19 pandemic caused a sudden and substantial increase in the use of 70% alcohol (w/v) for antisepsis. OBJECTIVES: To analyze the epidemiological characteristics of alcohol burns during the COVID-19 pandemic in participating Burn Treatment Centers, as well as the severity and treatment of these burns. METHOD: Descriptive, cross-sectional, quantitative and retrospective study based on data obtained from medical records of patients treated in participating Burn Treatment Centers. Data collection included origin, gender, education level, occupation, circumstance of the accident, wound depth and type of treatment. RESULTS: Of eight participating centers, theHospital da Restauraç ão Gov. Paulo Guerra Burn Treatment Center experienced the highest number of alcohol burn patients (38.4%) and male gender accounted for 53.6% of all cases. Predominant occupations were those that involve domestic activities (29%) and 48.6% of patients had not completed elementary school. The most common cause was an accident during cooking (35.5%) followed by suicide attempt (18.3%). More than half (58.6%) of the patients had concomitant second and third degree burns and wound treatment of choice was surgical (43.1%). CONCLUSIONS: The predominant population in this study was male, had a lower level of education, resided in the northeast region and had an occupation carried out in a domestic environment. The latter may reflect the population's longer stay at home due to social constraints caused by the COVID-19 pandemic. There were a large number of second and third degree burns and, as a consequence, a high number of cases in which surgical treatment was required.

Domestic burns that occurred during the COVID-19 pandemic in Brazil: a descriptive cross-sectional study.

BACKGROUND: Due to "stay at home" restrictions during the coronavirus disease 2019 (COVID-19) pandemic, people spent more time at home leading to an increase in home accidents, including burns. OBJECTIVE: To investigate the epidemiology of burns that occurred within homes during the COVID-19 pandemic in Brazil. DESIGN AND SETTINGS: This was a quantitative, descriptive, and cross-sectional study with a non-probabilistic sample. METHODS: Data were collected through the distribution of survey links on social networking sites and websites, and through email between December 2020 and February 2021. Participants were over 18 years of age, living in Brazil. Data analysis was performed using descriptive and dispersion statistics. RESULTS: A total of 939 adults (aged > 18 years) participated in this study. The mean age was 37.2 years (standard deviation [SD] = 12.5), 75.6% were female, 70.0% self-reported white skin color, 74% had completed higher education, and 28.1% had an income of 3 to 6 times the monthly minimum wage. A total of 21.6% suffered burns during the pandemic, 44.3% from a hot object. Approximately 49.3% never had access to a burn prevention campaign. CONCLUSION: It is necessary to develop burn prevention strategies that reach a wider population and to strengthen public policies to reduce the prevalence of domestic burns, especially during the pandemic.

Pavement Burns in New Mexico: Our Experiences, Treatments, and Outcomes.

This study focused on patients treated at the University of New Mexico Burn Center who sustained burn injuries from contact with environmentally heated pavement. We report on our patient demographics and outcomes as well as describe our institutional staged surgical approach to treatment. We provide a comparison of our results with other case reports as well as other findings. A retrospective review of patients admitted to the University of New Mexico Burn Center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A total of six patients were reviewed from 2018 to 2019. We looked at patient demographics and comorbidities, time of contact with hot pavement, inciting factors, total body surface area (TBSA) burned, location of areas burned, depth of burn injury at the time of presentation and at the time of initial operative debridement, percentage of autograft take, complications, length of stay (LOS), and final disposition. The patients in our study had a mean TBSA of 9.82% corresponding to pressure points of the body. All patients had nearly 100% conversion to full-thickness burns at the time of initial operative debridement. With staged excision and split-thickness autografting, our patients had nearly 100% take of their skin grafts with minimal graft loss or related complications. At the time of presentation, 100% of patients had AMS and 66% (4/6) had a drug- or alcohol-related inciting event. Finally, the average LOS was 19.5 days in comparison to 7 to 9 days for uncomplicated burns of equivalent size at our burn center. Despite an initial appearance of a partial-thickness burn, pavement burns had a high propensity to convert to full-thickness burns. Patients with AMS contributed to our patient population being found with pavement burns. Patients with pavement burns had a distinct anatomic pattern corresponding to pressure points of the body which were often areas at high risk for skin and wound breakdown and complications. Staged excision and split-thickness autografting in the treatment of pavement burns yielded excellent results. Finally, our data showed that providers must be prepared for an extended LOS for patients with pavement burns.

[Effects of COVID-19 lockdown on the demand for health care of children and adolescents with burns in three specialized outpatient centers in Chile]. / Efectos del confinamiento por COVID-19 en la demanda de atención de niñas, niños y adolescentes con quemaduras en tres centros ambulatorios especializados de Chile.

INTRODUCTION: COVID-19 pandemic has meant adapting to a different reality, with long-term lockdowns that might cause an increase of burns in children at home. OBJECTIVE: To compare the epidemiological situation of patients admitted to the Corporación de Ayuda al Niño Quemado (COANIQUEM) due to out patient burn injuries management at the beginning of COVID-19 lockdown with the same period the year before. PATIENTS AND METHODS: Analytical and cross-sectional study. A population of 2,027 patients under the age of 20, who were admitted to COANIQUEM for the first time with burn inju ries, between April and July of 2019 and 2020 was analyzed. The number of patients admitted each month was registered as well as their demographic, social, and clinical characteristics. The monthly percentage variation was calculated by comparing patient data in both years. RESULTS: During 2020, there was a 48.7% decrease in overall outpatient admissions. There was a relative increase of 10.5% in burns in patients under 5 years old, 18.3% in scalds, 33.1% in the number of burns in 3 or more body locations, and 16.8% in burns occurring at home. These parameters were not influenced by geographic location, sex, or socioeconomic level. CONCLUSIONS: In the first period of the COVID-19 pandemic, with strict lockdown strategies, there was a decrease in the demand for burn care, affecting both outpatients with acute burns and those who were admitted for sequelae rehabilitation, as a result of the effective decrease in the burns incidence and the reduced access to health care.

Fogo em campo cirúrgico - Medidas preventivas para cirurgia palpebral segura / Operating room fire prevention - preventive measures for safe eyelid surgery

Resumo Fogo em campo cirúrgico durante cirurgia palpebral é uma complicação intra-operatória que é dramática tanto para o paciente quanto para a equipe médica. Relatamos um caso de acidente cirúrgico durante cirurgia palpebral onde o paciente sofreu queimadura de supercílio. Houve interação entre o oxigênio usado para sedação (máscara aberta) e uma fonte de ignição representada pelo cautério monopolar. Embora o paciente tenha apresentado boa evolução clínica com recuperação total da lesão cutânea, este caso é um alerta para se evitar tais tipo de ocorrência. Ressaltamos neste trabalho quais as condições implicadas e o modo de prevenção.

Abstract Fire in the surgical field during eyelid surgery is an intra-operative complication that is dramatic for both the patient and the medical staff. It's being reported a case of surgical accident during eyelid surgery where the patient suffered a brow burn. There was interaction between the oxygen used for sedation (open mask) and a source of ignition represented by monopolar cautery. Although the patient presented good clinical evolution with complete recovery of the cutaneous lesion, this case is an alert to avoid such type of occurrence. This work highlights the conditions involved and the way of prevention.

Experimental models of scald burns. A scope review.

PURPOSE: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. METHODS: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. RESULTS: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. CONCLUSIONS: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.

Experimental models of scald burns. A scope review

Abstract Purpose: To conduct a scope review of the experimental model described by Walker and Mason, by identifying and analyzing the details of the method. Methods: The authors searched Pubmed-Medline, Cochrane-Bireme and PEDro databases for articles published between January 2016 and December 2018, using the following search queries: burns, burn injuries, models animal, and animal experimentation. All articles whose authors used Walker and Mason's model - with or without changes to the method in Wistar rats - were included in this study. Results: The search identified 45 mentions of Walker and Mason's model; however, after reading each summary, 20 were excluded (of which 5 due to duplicity). The inconsistencies observed after the scope review were: water temperature, length of time of exposure of the experimental model's skin to water, extent of the burnt area, and the description of the thickness/depth of the injury. Conclusions: Reproducibility of a scientific method is the basis to prove the veracity of the observed results. Thus, it is necessary to have a greater number of publications that adopt a reproducible scientific method, for this review found inconsistencies in the description of Walker and Mason's model.

Intervenciones enfermeras en el abordaje de las quemaduras / Nursing Interventions in Burns Management

RESUMEN Introducción: Las quemaduras están consideradas como uno de los traumatismos más severos y complicados que existen, debido a las consecuencias físicas y psicológicas que provocan en los pacientes. Las intervenciones de enfermería van encaminadas a realizar un tratamiento eficaz, basado en el conocimiento y juicio clínico, para favorecer el resultado esperado del paciente. Objetivo: Analizar las intervenciones enfermeras más eficaces para el abordaje de las quemaduras. Métodos: Se realizó una revisión bibliográfica sistemática con análisis de contenido de los documentos. Las bases de datos consultadas fueron: PubMed, CINAHL, Scopus, Dialnet, Cuiden plus, IME y MEDES. Los criterios de inclusión fueron: Artículos de investigación sobre el tópico de estudio, publicados entre 2011-2016 y con acceso a texto completo. Los descriptores fueron: Quemaduras, terapéutica, y atención de enfermería. Las estrategias iniciales de búsquedas identificaron un total de 216 resultados y finalmente se seleccionaron 18 estudios. Conclusiones: Se encontraron intervenciones de enfermería eficaces para el tratamiento y cuidado de las quemaduras, unas encaminadas al manejo del dolor, otras para el cuidado de la herida ocasionada por la quemadura y otras dirigidas hacia los cuidados de la piel. Para las complicaciones se mostraron eficaces la reanimación y movilización temprana y la terapia nutricional(AU)

ABSTRACT Introduction: Burns are considered as one of the most severe and complicated traumas that exist, due to the physical and psychological consequences that they cause in patients. Nursing interventions are aimed at performing an effective treatment, based on clinical knowledge and judgment, in order to favor the expected outcome of the patient. Objective: To analyze the most effective nursing interventions for the management of burns. Methods: A systematic literature review was carried out with analysis of the content of the documents. The databases consulted were PubMed, CINAHL, Scopus, Dialnet, Cuiden plus, IME and MEDES. The inclusion criteria were research articles on the topic of study, published between 2011-2016 and with full-text acces. The descriptors were quemaduras [burns], terapéutica [therapeutics], and atención de enfermería [nursing care]. Thorough initial search strategies a total of 216 results were identified and 18 studies were finally selected. Conclusions: Effective nursing interventions were found for the treatment and care of burns, aimed at pain management, wound care caused by the burn or directed towards skin care. Resuscitation, early mobilization and nutritional therapy were effective for complications(AU)

Efectividad del esquema de reposición hídrica de Brooke modificado para el tratamiento del paciente quemado / Effectiveness of the Modified Brooke Formula of Hydric Substitution for Management of the Burnt Patient

Introducción: La reanimación hídrica del paciente quemado es vital para su supervivencia, el esquema de Brooke modificado puede resultar un método efectivo para lograrlo. Objetivo: Determinar la efectividad del esquema de reanimación hídrica de Brooke modificado en las primeras 72 horas del ingreso. Métodos: Estudio descriptivo, de corte transversal, realizado en pacientes quemados graves ingresados en el servicio de Caumatología y Cirugía Plástica del Hospital Universitario "Dr. Miguel Enríquez" de La Habana durante 2014. Universo de 211, se seleccionó una muestra probabilística sistemática de 80 pacientes, conformándose tres grupos según el pronóstico de grave (40), crítico (17) y crítico extremo (23). Se utilizaron técnicas estadísticas de distribución de frecuencia absoluta y porcentaje, a las variables estudiadas se les calculó desviación estándar considerándose un nivel de significancia para p < 0.05. Resultados: Predominó el sexo masculino (67,50 por ciento), la edad de 40 a 49 años en 45,00 por ciento, la categoría de grave (50,00 por ciento), 46,25 por ciento de los casos se comenzó a reanimar entre 4 y 8 horas de ocurrido el insulto térmico. La taquicardia y la sed fueron los parámetros clínicos de mayor importancia en las fases de reanimación (97,50 por ciento y 73,75 por ciento) y posreanimación (26,25 por ciento y 13,75 por ciento), disminuyeron en más de 70,00 por ciento de una etapa a otra. Conclusiones: En la fase de posreanimación de los pacientes quemados, los parámetros clínicos evaluados mejoraron en más de 70 por ciento, siendo esto un indicador satisfactorio de la eficacia de la utilización del esquema de Brooke modificado(AU)

ABSTRACT Introduction: Hydric resuscitation is vital for the survival of the burnt patient; the modified Brooke formulas can be used as an effective method to achieve it. Objective: To determine the effectiveness of the modified Brooke formula for hydric resuscitation in the first 72 hours of admission. Methods: Descriptive, cross-sectional study carried out with severely burnt patients admitted to the Caumatology and Plastic Surgery Department of Dr. Miguel Enríquez University Hospital of Havana, during 2014. Study population of 211, a systematic probabilistic sample of 80 patients was chosen, three groups being formed according to the prognosis of severe (40), critical (17) and extremely critical (23). Statistical techniques of absolute frequency and percentage distribution were used; for the variables studied, we calculated standard deviation considering a level of significance for p < 0.05. Results: There was a predominance of the male sex (67.50 percent), age 40-49 years (45.00 percent), the category of serious (50.00 percent), 46.25 percent of the cases began to be resuscitated from 4 to 8 hours after the thermal insult occurred. Tachycardia and thirst were the most important clinical parameters in the phases of resuscitation (97.50 percent and 73.75 percent) and post-resuscitation (26.25 percent and 13.75 percent), decreased by more than 70.00 percent from one stage to another. Conclusions: In the post-resuscitation stage of the burnt patients, the evaluated clinical parameters improved by more than 70 percent, this being a satisfactory indicator of the effectiveness of the use of the modified Brooke formula(AU)

Análise epidemiológica de 2 anos na Unidade de Queimados do Hospital de Urgências Governador Otávio Lage de Siqueira, Goiânia, Brasil / Epidemiological analysis over 2 years at the Burn Unit of the Urgency Hospital Governor Otávio Lage de Siqueira, Goiânia, Brazil

Introdução: Queimadura é um tipo de lesão que está entre as principais causas de mortalidade. A utilização da epidemiologia ajuda no fornecimento de subsídios para avaliação e organização de tratamento e prevenção, visando à melhora da saúde pública. O objetivo é descrever o perfil epidemiológico dos pacientes atendidos no Hospital de Urgências Governador Otávio Lages de Siqueira (HUGOL) na unidade de Queimados Nelson Picollo. Método: Este estudo analisou o perfil epidemiológico dos pacientes atendidos pela equipe de cirurgia plástica da unidade de tratamento de queimados Nelson Picollo, no período de julho 2015 até junho 2017, com idade superior a 12 anos. Critérios de exclusão: pacientes que não foram internados na unidade de queimados. Os dados foram colhidos do programa MVSoul R. Resultados: O total de atendimentos foi de 375 pacientes, dos quais 50% necessitaram de tratamentos unidade de terapia intensiva. O tempo médio de internação foi de 23,08 dias. A maioria do sexo masculino, com média de idade de 39,17 anos, com agente etiológico principal as chamas por álcool + gasolina. A média de superfície corporal queimada foi de 24,67%. Foram realizados 1490 intervenções cirúrgicas, média de 3,97 cirurgias por paciente. O total de óbitos foi de 40 pacientes, dos quais 29 apresentaram queimadura de via aérea. O total de pacientes com queimadura de via aérea foi de 73 casos. Conclusão: Este estudo demonstrou um perfil de queimaduras e internações na unidade de Queimados do HUGOL compatível com outros centros especializados neste tipo de tratamento.

Introduction: Burns are a type of injury that is among the leading causes of mortality. The use of epidemiology helps in providing subsidies for evaluation and organization of treatment and prevention, aiming at the improvement of public health. The objective is to describe the epidemiological profile of the patients treated at the Queimados Nelson Picollo unit of the Governador Otávio Lages de Siqueira Emergency Hospital (HUGOL). Method: This study analyzed the epidemiological profile of patients, aged more than 12 years, treated by plastic surgery at the burn treatment unit, Nelson Picollo, from July 2015 to June 2017. The patients who were not admitted to the burn unit were excluded from the study. Data were collected from the MVSoul R. program. Results: A total of 375 patients visited the hospital; of these, 50% of the patients needed intensive care unit treatments. The mean duration of hospital stay was 23.08 days. The majority of the patients were males, with a mean age of 39.17 years, and the main etiological agents were inflammable liquids, mainly alcohol and gasoline. The mean burned body surface area was 24.67%. A total of 1490 surgical interventions were performed, with an average of 3.97 surgeries per patient. Forty patients died; of these, 29 had airway burns. The total number of patients with airway burns was 73. Conclusion: This study provides a profile of burns and hospitalizations in the HUGOL burns unit, which corresponds with those from other centers specialized for this type of treatment.

Challenging the immediate causes: A work accident investigation in an oil refinery using organizational analysis.

BACKGROUND: In many companies, investigations of accidents still blame the victims without exploring deeper causes. Those investigations are reactive and have no learning potential. OBJECTIVE: This paper aims to debate the historical organizational aspects of a company whose policy was incubating an accident. METHODS: The empirical data are analyzed as part of a qualitative study of an accident that occurred in an oil refinery in Brazil in 2014. To investigate and analyse this case we used one-to-one and group interviews, participant observation, Collective Analyses of Work and a documentary review. The analysis was conducted on the basis of concepts of the Organizational Analysis of the event and the Model for Analysis and Prevention of Work Accidents. RESULTS: The accident had its origin in the interaction of social and organizational factors, among them being: excessively standardized culture, management tools and outcome indicators that give a false sense of safety, the decision to speed up the project, the change of operator to facilitate this outcome and performance management that encourages getting around the usual barriers. CONCLUSIONS: The superficial accident analysis conducted by the company that ignored human and organizational factors reinforces the traditional safety culture and favors the occurrence of new accidents.

LED phototherapy in full-thickness burns induced by CO2 laser in rats skin.

Many studies have been conducted on the treatment of burns because they are important in morbidity and mortality. These studies are mainly focused on improving care and quality of life of patients. The aim of this study was evaluate the LED phototherapy effects in rats skin full-thickness burns induced by CO2 laser. The animals were divided in NT group that did not received any treatment and LED group that received LED irradiation at 685 nm, 220 mW, and 4.5 J/cm2 during 40 s by burned area. Biopsies were obtained after 7, 14, and 21 days of treatment and submitted to histological and immunohistochemical analysis. The LED phototherapy shows anti-inflammatory effects, improves angiogenesis, and stimulates the migration and proliferation of fibroblasts. The T CD8+ lymphocytes were more common in burned areas compared to T CD4+ lymphocytes since statistically significant differences were observed in the LED group compared to the NT group after 7 days of treatment. These results showed that LED phototherapy performs positive influence in full-thickness burns repair from the healing process modulated by cellular immune response. The obtained results allowed inferring that burns exhibit a characteristic cell immune response and this cannot be extrapolated to other wounds such as incision and wounds induced by punch, among others.

Quemaduras en niños provocadas por rotura de bolsa para agua caliente / Children's scalds from tearing of hot water bottle

INTRODUCCIÓN: La quemadura en niños por rotura de bolsa de agua caliente, presentó un incremento brusco y significativo alrededor del año 2000 en Chile. Ante ello, la Corporación de Ayuda al Niño Quemado (COANIQUEM) difundió conceptos de prevención en su uso y alerta a autoridades. Posteriormente el Instituto de Normalización Nacional introdujo normativas de certificación de calidad de los productos comercializados en el país. OBJETIVO: Determinar el impacto de medidas preventivas y de certificación de calidad de las bolsas de agua caliente en las quemaduras por rotura del producto en niños. PACIENTES Y MÉTODO: Revisión de ingresos de 795 pacientes menores de 15 años, con quemaduras por rotura de bolsa de agua caliente, entre 2000-2014, en COANIQUEM-Santiago. Se determinó evolución de las frecuencias de quemaduras por el agente etiológico y se comparó el perfil epidemiológico en los períodos quinquenales inicial y final. RESULTADOS: Entre 2000-2004, se registró un incremento de 272,7% en los ingresos y un descenso de 81,3% entre 2005-2014. Las características demográficas, mes de ocurrencia de las quemaduras y necesidad de algún tipo de cirugía, fueron similares en los períodos comparados. El número de localizaciones disminuyó concentrándose en una quemadura (77,8%). En el segundo período incluyó además de extremidad inferior, abdomen y pelvis como ubicaciones frecuentes. CONCLUSIONES: Se verifica un importante descenso de las quemaduras por bolsa de agua caliente en niños, y un cambio significativo en sus características epidemiológicas, coincidiendo con medidas de prevención y normativa de certificación de calidad de los implementos.

INTRODUCTION: Children scalded by the tearing of hot-water bottles presented a sudden and significa tive increase around 2000 in Chile. For this reason the Aid to Burned Children Corporation (COA-NIQUEM) publicized prevention concepts concerning the careful use of this device and raised a voice of alarm to authorities. Later, the National Normalization Institute introduced quality certification standards for hot water bottles sold in the country. OBJECTIVES: Determine the impact of preventive measures and quality certification for hot water bottles in burns caused by tearing of the device on children. PATIENTS AND METHOD: Review of 795 patients under 15 admitted with injuries caused by hot-water bottle rupture between 2000 and 2014 at COANIQUEM Santiago. The frecuency of burns by the ethiological agent is determined and the epidemiological profile are compared in the initial and final quinquenial period. RESULTS: Between 2000-2004, an increase of 272.7% was recorded and then a decrease of 81.3 % was found between 2005-2014. Demographic characteristics, month of occurrence and need of some kind of surgery were similar in both periods. The number of locations and injuries diminished, and are concentrated in one burn (77.8%). In the first period the main anatomical region affected was lower limbs and in the second period abdominal and pelvis are also frequent. CONCLUSIONS: An important decrease of burns by hot-water bottle rupture with significant changes in their epidemiological characteristic is verified. This coincides with preventive measures and manufacturing standards regulations and quality control.

Edema laringotraqueal a causa de una lesión térmica: Complicación tras una tiroidectomía en niños / Laryngotracheal edema due to thermal injury: A complication after thyroidectomy in children

La insuficiencia respiratoria posoperatoria es una complicación grave de la tiroidectomia, y su origen puede ser multifactorial, especialmente en los niños. Presentamos el caso de dos hermanos sometidos a una tiroidectomia que luego tuvieron dificultad respiratoria. Para la disección de la tiroides se emplearon un bisturí armónico y el sistema de sellado vascular bipolar electrotérmico. Ambos pacientes presentaron problemas para respirar tempranamente en el posoperatorio. El hermano mayor tuvo dificultad respiratoria leve durante 24 horas, que se resolvió espontáneamente. Se extubó a la hermana menor, pero tuvo estridor grave acompañado de tiraje intercostal y retracción abdominal. Se la volvió a intubar y se la trasladó a la UCI, donde se la conectó a un respirador. Permaneció en la UCI durante 14 días debido a múltiples intentos fallidos de extubación. Es probable que los síntomas fueran más graves en la niña pequeña debido a que la pared de la tráquea era más blanda y los cartílagos, más débiles. Es necesario considerar las posibles complicaciones respiratorias posoperatorias a causa de una lesión térmica o una técnica quirúrgica inadecuada tras una tiroidectomía.

Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.

Laryngotracheal edema due to thermal injury: A complication after thyroidectomy in children. / Edema laringotraqueal a causa de una lesión térmica: Complicación tras una tiroidectomía en niños.

Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.

La insuficiencia respiratoria posoperatoria es una complicación grave de la tiroidectomía, y su origen puede ser multifactorial, especialmente en los niños. Presentamos el caso de dos hermanos sometidos a una tiroidectomía que luego tuvieron dificultad respiratoria. Para la disección de la tiroides se emplearon un bisturí armónico y el sistema de sellado vascular bipolar electrotérmico. Ambos pacientes presentaron problemas para respirar tempranamente en el posoperatorio. El hermano mayor tuvo dificultad respiratoria leve durante 24 horas, que se resolvió espontáneamente. Se extubó a la hermana menor, pero tuvo estridor grave acompañado de tiraje intercostal y retracción abdominal. Se la volvió a intubar y se la trasladó a la UCI, donde se la conectó a un respirador. Permaneció en la UCI durante 14 días debido a múltiples intentos fallidos de extubación. Es probable que los síntomas fueran más graves en la niña pequeña debido a que la pared de la tráquea era más blanda y los cartílagos, más débiles. Es necesario considerar las posibles complicaciones respiratorias posoperatorias a causa de una lesión térmica o una técnica quirúrgica inadecuada tras una tiroidectomía

[Children's scalds from tearing of hot water bottle]. / Quemaduras en niños provocadas por rotura de bolsa para agua caliente.

INTRODUCTION: Children scalded by the tearing of hot-water bottles presented a sudden and significa tive increase around 2000 in Chile. For this reason the Aid to Burned Children Corporation (COA-NIQUEM) publicized prevention concepts concerning the careful use of this device and raised a voice of alarm to authorities. Later, the National Normalization Institute introduced quality certification standards for hot water bottles sold in the country. OBJECTIVES: Determine the impact of preventive measures and quality certification for hot water bottles in burns caused by tearing of the device on children. PATIENTS AND METHOD: Review of 795 patients under 15 admitted with injuries caused by hot-water bottle rupture between 2000 and 2014 at COANIQUEM Santiago. The frecuency of burns by the ethiological agent is determined and the epidemiological profile are compared in the initial and final quinquenial period. RESULTS: Between 2000-2004, an increase of 272.7% was recorded and then a decrease of 81.3 % was found between 2005-2014. Demographic characteristics, month of occurrence and need of some kind of surgery were similar in both periods. The number of locations and injuries diminished, and are concentrated in one burn (77.8%). In the first period the main anatomical region affected was lower limbs and in the second period abdominal and pelvis are also frequent. CONCLUSIONS: An important decrease of burns by hot-water bottle rupture with significant changes in their epidemiological characteristic is verified. This coincides with preventive measures and manufacturing standards regulations and quality control.