Temperatura corporal y temperatura de calentamiento en el cuidado de pacientes grandes quemados / Body temperature and heating temperature in major burns patients care

OBJETIVOS: El objetivo es describir los métodos de calentamiento y su aplicación para el mantenimiento de la temperatura corporal en el paciente gran quemado. METODOLOGÍA: Revisión bibliográfica realizada entre septiembre de 2019 y febrero de 2020 acerca de la termorregulación y calentamiento del paciente quemado en las bases de datos CINAHL, CUIDEN, PUBMED, MEDES y WOS en español e inglés, de los últimos 10 años, de los cuales fueron analizados 24 documentos. RESULTADOS: La respuesta hipermetabólica y la reprogramación hipotalámica provocan un aumento de la temperatura basal en los pacientes quemados, entre 37 y 38,5ºC sin origen infeccioso. Para disminuir el gasto energético en reposo y la repuesta hipermetabólica se puede aplicar una temperatura ambiental elevada, como calentamiento externo pasivo, entre 28 y 32ºC. DISCUSIÓN: Existen otros métodos de calentamiento externo activo que pueden conseguir el mismo objetivo como las mantas de aire convectivo, placas térmicas o sistemas de superficie. CONCLUSIÓN: Debe revisarse la recomendación de calentamiento mediante temperatura ambiental elevada, que crea ambientes hostiles para los trabajadores y los pacientes, a través del estudio de la inclusión de métodos de calentamiento externo activo

OBJECTIVES: To describe the heating methods and their application to maintain body temperature in majors burn patients. METHODOLOGY: Bibliographic review carried out between September 2019 and February 2020 about the thermoregulation and heating of the burn patient in the CINHAL, CUIDEN, PUBMED, MEDES and WOS databases in Spanish and English, documents from the last 10 years, from which 26 were analyzed. RESULTS: Hypermetabolic response and hypothalamic reprogramming cause an increase in basal temperature in burn patients between 37 and 38.5ºC without infectious origin. To decrease the energy expenditure at rest and the hypermetabolic response, it is possible to act through a high ambient temperature between 28 and 32ºC as passive external heating. DISCUSSION: Other external heating methods can achieve this goal such as convective air blankets, heating plates, or surface systems. CONCLUSIONS: The recommendation of warming by means of high ambient temperature, which creates hostile environments for workers and patients, should be reviewed through the study of the inclusion of active external warming methods

Occupational exposure to cytostatic fumes during hyperthermic intraperitoneal chemotherapy.

Hyperthermic intraperitoneal chemotherapy (HIPEC)-heated, intra-abdominal chemotherapy-has become the treatment of choice for treating peritoneal metastases from ovarian, stomach or colorectal cancers. HIPEC has several advantages and disadvantages. The major benefit is minimal systemic toxicity for the patient, but there is a risk of occupational exposure for operating room staff. We have not found any reports of workers with chronic aplastic anaemia as a result of exposure to cytostatic fumes during HIPEC. The aim of this case report is to raise the awareness of potential negative health effects of inhalation exposure to cytostatic drugs. We present a rare case of a 43-year-old woman, suffering from aplastic anaemia as a long-term consequence of exposure to cytostatics. During the HIPEC procedure, surgical revision of the peritoneal cavity was undertaken which resulted in release of cytostatic fumes. Despite awareness of the health effects of occupational exposure to cytostatic drugs and well-developed procedures for safely handling them, unexpected exposure may occur causing serious medical conditions. These may develop in sensitive subjects although accidental high-level exposure may lead to unexpected long-term consequences in all workers. Medical staff need to be informed of the risks of HIPEC and safety guidelines to reduce the risk of exposure.

Quimioterapia hipertérmica intraperitoneal transoperatória: o que a enfermagem precisa saber / Intraoperative hyperthermic intraperitoneal chemotherapy: what nurses should know / Quimioterapia intraperitoneal hipertérmica transoperatória: qué necesita saber la enfermería

Objetivo: apresentar o estado do conhecimento científico sobre quimioterapia hipertérmica intraperitoneal transoperatória no tratamento da carcinomatose peritoneal e os cuidados de enfermagem pós-operatórios para pacientes submetidos a essa terapia. Métodos: apresentam-se aspectos técnicos da quimioterapia hipertérmica intraperitoneal transoperatória, suas complicações potenciais e cuidados de enfermagem pós-operatórios envolvidos. Resultados: destaca-se a importância dos cuidados de enfermagem, quais sejam: monitorar sinais vitais, perfusão periférica, débito cardíaco e pressão venosa central; avaliar dor; encorajar tosse e realização de exercícios de respiração profunda; registrar drenagem de ferida operatória e drenos; investigar ruídos intestinais; medir volume residual gástrico; promover mudanças de decúbito; avaliar resultados laboratoriais de exames sanguíneos; instituir balanço hídrico e; aferir peso corporal. Conclusão: a quimioterapia hipertérmica intraperitoneal transoperatória é terapia promissora no tratamento de pacientes com carcinomatose peritoneal. Entretanto, para ser bem-sucedida, a prestação de cuidados de enfermagem é fundamental.

Objective: to present the current state of scientific knowledge about intraoperative hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis, and postoperative nursing care for patients undergoing this therapy. Methods: the study describes technical aspects of intraoperative hyperthermic intraperitoneal chemotherapy, the potential complications and post-operative nursing care involved. Results: emphasis was placed on the importance of nursing care, viz.: monitoring of vital signs, peripheral perfusion, cardiac output, and central venous pressure; pain assessment; encouraging coughing and deep breathing exercises; recording drainage of surgical wound and drains; investigating bowel sounds; measuring gastric residual volume; ensuring change of decubitus; evaluating laboratory blood test results; establishing water balance; and measuring body weight. Conclusion: intraoperative hyperthermic intraperitoneal chemotherapy has been shown to be a promising therapy in treatment of patients with peritoneal carcinomatosis. However, to be successful, the nursing care provided is fundamental.

Objetivo: presentar el estado del conocimiento científico sobre quimioterapia intraperitoneal hipertérmica transoperatoria en el tratamiento de la carcinomatosis peritoneal y los cuidados de enfermería posoperatorios para pacientes sometidos a ella. Métodos: se presentan aspectos técnicos de la quimioterapia intraperitoneal hipertérmica transoperatoria, sus complicaciones potenciales y cuidados de enfermería posoperatorios involucrados. Resultados: se destaca la importancia de los cuidados de enfermería: monitorear señales vitales, perfusión periférica, débito cardíaco, presión venosa central; evaluar dolor; estimular la tos y realización de ejercicios de respiración profunda; registrar drenaje de herida operatoria y drenes; investigar ruidos intestinales; medir volumen residual gástrico; promover cambios de decúbito; evaluar resultados de análisis de sangre en laboratorio; establecer balance hídrico; verificar peso corporal. Conclusión: la quimioterapia intraperitoneal hipertérmica transoperatoria es terapia prometedora en el tratamiento de pacientes con carcinomatosis peritoneal. Sin embargo, para ser exitosa, la prestación de cuidados de enfermería es fundamental.

Effects of local heat application before intravenous catheter insertion in chemotherapy patients.

AIMS AND OBJECTIVES: To characterise the effects of local heat application on the ease of subsequent intravenous catheter insertion. BACKGROUND: Intravenous catheter insertion is a challenging procedure for both nurses and chemotherapy patients. The local application of heat to the area before intravenous catheter insertion may decrease these difficulties by increasing venous distension and visibility. DESIGN: This study was an open label experimental study involving intervention and control groups. METHODS: Patients receiving chemotherapy were divided into intervention (n = 40) and control (n = 40) groups. For patients in the intervention group, a digital moist heating pad was applied to the arm prepared for catheter insertion for 10 minutes in addition to routine care. No additional preparation procedure beyond routine care was performed for control patients. Data were collected using a data collection form and evaluated using chi square, Fisher's exact chi square, Student's t, Mann-Whitney U, Wilcoxon and Pearson correlation tests. RESULTS: Local application of heat decreased patients' pain (p = 0·011), increased the rate of successful catheter placement at first attempt (p = 0·004), decreased the catheterisation procedure time (p = 0·001) and decreased nurse-perceived difficulty during catheter placement (p = 0·001). CONCLUSIONS: Local application of heat before the catheterisation procedure is suggested for patients receiving chemotherapy, particularly in cases where visibility of the veins is poor and intravenous catheter insertion is difficult. RELEVANCE TO CLINICAL PRACTICE: Local application of heat results in vasodilation, and thus intravenous catheter insertion becomes easier. Our findings have important implications for nurses who care for chemotherapy patients. The inclusion of local heat application before catheterisation as a preparation step is suitable to be implemented by nurses in other hospitals and clinics where chemotherapy is provided.

Aplicación de termoterapia en el periné durante el parto para reducir las lesiones que precisan sutura posparto / Application of perineum heat therapy during partum to reduce injuries that require post-partum stitches

OBJETIVO: Evaluar la eficacia de la termoterapia, húmeda o seca, en el periné durante el parto para reducir las lesiones que precisan sutura posparto y valorar su seguridad en relación a la adaptación del recién nacido a la vida extrauterina. MÉTODO: Ensayo clínico multicéntrico, abierto, dirigido desde la Escuela de Enfermería de la Universidad de Barcelona y realizado durante los años 2009-2010 en 5 hospitales catalanes. La muestra fue de 198 gestantes a las que se aplicó el protocolo para la asistencia natural al parto normal. Se realizó una asignación aleatoria a los 3 grupos de estudio: grupo control (GC), calor húmedo (GCH) o calor seco (GCS). Durante el expulsivo se realizó en todos los grupos el cuidado habitual del periné y en los grupos de intervención se aplicó, además, GCH o GCS en el periné. Posteriormente se valoró el estado del periné posparto y el test de Apgar en el neonato. Se realizaron pruebas de contraste estadístico utilizando un intervalo de confianza del 95% y análisis estadístico con PASW 17. RESULTADOS: Perinés sin sutura: GCH 71% (47) versus GC 56% (37), OR: 1.803 (IC:95%:0,881-3,687); GCS 62% (41) versus GC 56% (37), OR:1.285 (IC:95%:0,641-2,577); GCH 71% (47) versus GCS 62% (41), OR:1.402 (IC:95%:0,680-2,890). Medias test de Apgar 5', GCH: 9,91; GCS: 9,98; GC: 9,98. p = 0,431. CONCLUSIONES: La aplicación de termoterapia en el periné no redujo la sutura perineal durante el parto. Se obtuvieron mejores resultados perineales con la termoterapia húmeda. La termoterapia no modificó los resultados neonatales medidos mediante test de Apgar

OBJECTIVE: Evaluate the effectiveness of heat, moist or dry to the perineum during delivery in order to reduce injuries requiring perineal suturing after birth, and to assess its safety in relation to the adaptation of the newborn to extrauterine life. METHOD: An open multicentre clinical trial directed from the School of Nursing at the University of Barcelona was carried out between 2009 and 2010 in 5 Catalan Hospitals. The sample consisted of 198 pregnant women subjected to the natural protocol for normal delivery assistance. The pregnant women were randomized to three study groups: moist heat (MHG), dry heat (DHG), and control (CG). Usual care of the perineum was performed during labour in all groups and MHG or GCS was also applied in the perineum in the intervention groups. The Apgar score in the newborn and perineum postpartum was then assessed. Statistical tests were performed using a 95% confidence interval. Statistical analyses were performed using the SPSS version 17. RESULTS: Perinea that required no suturing: MHG 71% (47) versus CG 56% (37), OR: 1.803; (95% CI: 0.881-3.687); DHG 62% (41) versus CG 56% (37), OR:1.285 (95% CI: 0.641-2.577); MHG 71% (47) versus DHG 62% (41), OR:1.402 (95% CI: 0.680-2.890). Mean: Apgar score 5', MHG: 9.91; DHG: 9.98, CG: 9.98. p = 0.431. CONCLUSIONS: The application of heat therapy to the perineum during labour did not significantly reduce perineal suturing after birth. However, better perineal results were observed with moist heat. Heat therapy does not alter neonatal outcomes measured by Apgar score

Care of the open abdomen after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies.

A patient with a mucinous appendiceal cancer presents to the surgeon complaining of abdominal discomfort and nausea. Having undergone a prior right hemicolectomy, the patient has been disease free and on surveillance with clinical and carcinogenic antigen (CEA) monitoring. The CEA was noted to be elevated and a computed tomography scan revealed peritoneal nodules throughout the abdomen with a presumptive diagnosis of pseudomyxoma peritonei (progressive peritoneal implants from a mucinous primary). Several therapeutic options were offered and the patient selected to undergo cytoreductive surgery (CRS) with the potential to receive hyperthermic interoperative chemotherapy (HIPEC). Extensive resection was performed, including removal of the entire greater omentum, partial gastrectomy, and total pelvic exenteration with end colostomy and ileal conduit. Reassessment of the peritoneal cavity after the resections revealed almost complete cytoreduction. HIPEC was performed with mitomycin C and, after drainage and abdominal washing, the intestinal segments were anastomosed and the abdominal wall closed. Seven days postoperatively, an acute abdomen with septic shock developed as a result of a leak from the ileocolonic anastomosis. The patient returned to the operating room and an exploratory laparotomy, a small bowel resection, a resection of the ileocolonic anastomosis, and an abdominal washout were performed. Edema of the bowel caused by peritonitis resulting from the anastomotic leak necessitated delayed closure of the abdominal wall. A temporary abdominal closure using the ABThera™ Open Abdomen Negative Pressure Therapy system was applied and the abdomen was eventually closed.

Hipertermia. La modificación de la temperatura corporal como terapéutica clínica / Hyperthermia. Modification of body temperature as clinical therapeutics

La aplicación de calor o frío como terapéutica se denomina termoterapia. Ha sido empleada desde la antigüedad: egipcios, griegos y romanos utilizaban la radiación solar o la sumersión en manantiales para aplicar calor y el hielo o la nieve para el frío. Las primeras referencias científicas relacionadas con la termoterapia aparecen a finales del siglo XVIII, pero en el siglo XX se han introducido nuevas modalidades de termoterapia profunda que han ampliado sus posibilidades; así mismo su aplicación superficial cuenta con medios más cómodos y eficaces. La termoterapia, si bien requiere más experimentación para la obtención de una sólida evidencia científica que avale su uso, está levantando grandes expectativas como terapéutica en diversos campos: oncología, cirugía, neurología, etc. En el campo quirúrgico la ablación térmica se ha utilizado con éxito en el tratamiento de diversas patologías, hiperplasia benigna de próstata, tumores hepáticos y ginecológicos, entre otros. En el campo de la oncología se ha evidenciado que la diatermia mejoraría los resultados administrada en conjunción con quimio y radioterapia. Basándonos en la revisión de la bibliografía, se describirán los principales usos de la modificación de la temperatura como terapéutica, las principales indicaciones de estas técnicas, su forma de aplicación, la evidencia existente sobre sus beneficios y las complicaciones que se derivan de su manejo(AU)

The application of heat or cold therapy is called thermotherapy. Thermotherapy has been used since ancient times, Egyptians, Greeks and Romans used solar radiation or submersion in springs to apply heat and ice and snow for cold application. The first scientific references related to thermotherapy appear in late eighteenth century, but the twentieth century when the introduction of new forms of deep heat therapy have expanded their capabilities and their operation with media surface more comfortable and effective. Thermotherapy, although they require more experimentation to obtain a solid scientific proof that their use is raising great expectations in various fields such as oncology treatment, surgery, neurology, etc. In the surgical field thermal ablation has been used successfully in the treatment of various diseases, benign prostatic hyperplasia, liver and gynecological tumors, among others. In the field of oncology has been shown to improve outcomes diathermy applied in conjunction with chemo and radiation therapy. Based on the literature review, describing the main uses of the change in temperature as a therapeutic, the main indications for these techniques, as applicable, evidence of its benefits and complications arising from their use(AU)

Hipotermia. La modificación de la temperatura corporal como terapéutica clínica / Modification of body temperature as clinical therapeutics. Hypothermia

La aplicación del frío como terapéutica se denomina termoterapia. Se pueden diferenciar dos grandes modalidades: local y general. A nivel local es muy utilizada en el campo de la rehabilitación física, reumatología, y en diversas especialidades quirúrgicas. No obstante, la evidencia existente sobre aspectos relacionados con sus posibles beneficios, razón fisiológica que fundamenta su acción, o forma de aplicación no está suficientemente respaldada. Respecto a las técnicas de aplicación de frío, las mayores expectativas se centran en la hipotermia inducida o terapéutica, por sus importantes efectos neuroprotectores tras isquemia secundaria a parada cardiorrespiratoria. El interés por la hipotermia comienza en el tercer decenio del siglo xx; el primer informe científico sobre la hipotermia inducida fue publicado en 1945 y describía su aplicación en pacientes con TCE. En las siguientes décadas aparecieron decisivas investigaciones sobre su aplicación, pero también grandes sombras sobre sus beneficios. El desarrollo de protocolos y los grandes avances en los cuidados prestados en las UCI, han aumento la capacidad de prevenir y controlar los efectos secundarios de la aplicación de esta terapéutica. Basándonos en la revisión de la bibliografía, se describirán los principales usos de la hipotermia terapéutica, las principales indicaciones de estás técnicas así como la evidencia existente sobre sus beneficios y las complicaciones que se derivan de su manejo(AU)

The application of cold therapy is called thermotherapy. Can distinguish two major forms: local and general. At the local level is widely used in the field of physical rehabilitation, rheumatology, and various surgical specialties. However, the evidence on issues relating to its potential benefits, physiological reason underlying its action, or application form is not sufficiently supported. Regarding the application of cold techniques, higher expectations are focused on hypothermia induced or therapeutic, for its significant neuroprotective effects after ischemia secondary to cardiac arrest. Interest in hypothermia begins in the third decade of the twentieth century, the first scientific report on induced hypothermia was published in 1945 and described its application in patients with TBI. In the following decades appeared critical research on their application, but also great shadows of its benefits. The development of protocols and the great advances in the care provided in ICUs, have increased the capacity to prevent and control the side effects of the application of this therapy. Based on the literature review, describing the main uses of therapeutic hypothermia, the major indications of these techniques and the evidence of its benefits and complications arising from their use(AU)

Safe heat application for pediatric patients: a hot item.

Topical heat application has a number of therapeutic uses in nursing practice. However, factors such as surface temperature and duration of heat exposure to the modality used may result in accidental burning. The purpose of this clinical project was to find an effective and safe method of heat application for the pediatric population. Based on literature findings, the practice of heat therapy requires careful consideration of the benefits and risks involved and vigilant monitoring.

The impact of dry versus moist heat on peripheral IV catheter insertion in a hematology-oncology outpatient population.

PURPOSE/OBJECTIVES: To determine whether dry versus moist heat application to the upper extremity improves IV insertion rates. DESIGN: Two-group, randomized, controlled clinical design. SETTING: An academic cancer infusion center in the western United States. SAMPLE: 136 hematologic outpatients with cancer or other malignancies. METHODS: Participants were randomly assigned to dry or moist heat with warmed towels wrapped around each patient's arm for seven minutes prior to IV insertion. Skin and room temperatures were monitored pre- and postwarming. Two experienced chemotherapy infusion nurses performed the venipunctures according to protocol. Outcomes were examined using variance analysis, with 34 patients for each combination of nurse and heat type. MAIN RESEARCH VARIABLES: Number of IV insertion attempts, time to achieve IV insertion postheating, patient anxiety levels pre- and postheating, and patient comfort. FINDINGS: Dry heat was 2.7 times more likely than moist heat to result in successful IV insertion on the first attempt, had significantly lower insertion times, and was more comfortable. Heat type had no effect on patient anxiety. CONCLUSIONS: Dry heat application decreases the likelihood of multiple IV insertion attempts and procedure time and is comfortable, safe, and economical to use in an outpatient oncology setting.

Intravascular temperature control system to maintain normothermia in organ donors.

INTRODUCTION: Temperature regulation in humans is controlled by the hypothalamus. After death by neurological criteria, the hypothalamus ceases to function and poikilothermia ensues. Preservation of normothermia in those patients destined to become organ donors is an important part of maintaining the normal physiology of the organs and organ systems. Typical means of achieving normothermia include increasing the temperature of the ambient air, infrared warming lights, instillation of warmed intravenous fluids, and warm air or water blankets. METHODS: In this prospective case series of five organ donors, we used an intravascular temperature modulation catheter (Alsius, Irvine, CA) to maintain normothermia in organ donors declared dead by neurological criteria. Data on accuracy of temperature maintenance at 37 degrees C and nursing ease of use were collected. RESULTS: This intravascular temperature modulation catheter provided an accurate method of temperature regulation in brain death donor and easier to use from a nursing workload perspective. CONCLUSIONS: Intravascular warming is a viable method for the maintenance of normothermia in organ donors. The experience here provides some insight into the ability of these devices to warm patients in other clinical situations.

Theoretical comparison of intraluminal heating techniques.

INTRODUCTION: This study compared simulated temperature distributions of intraluminal heating devices, concerning penetration and homogeneity. A hot water balloon, a 434-MHz monopole and a 915-MHz dipole antenna, both with incorporated cooling, and a 27-MHz applicator were investigated. METHODS: The hot water balloon had an inlet temperature of 45 degrees C and a flow rate of 7.85 ml s(-1). The cooling water and air had a temperature of 41 degrees C and 37 degrees C and a flow rate of 5.89 ml s(-1) and 1.8 l s(-1), respectively. A 27-MHz applicator consisting of one or two electrode(s) was modelled to demonstrate axial steering for inhomogeneous tissue properties. Calculated power distributions were scaled to a total power of 10 W in tissue before the corresponding temperature distributions were calculated. RESULTS: The hot water balloon and the 27-MHz device showed a thermal penetration depth of approximately 4 and approximately 10 mm, respectively. The penetration depths of the 434- and 915-MHz applicators were comparable: approximately 10 and approximately 16 mm with water and air cooling, respectively. With the 27-MHz applicator, spatial steering was applied to minimize temperature gradients along the applicator. The 434- and 915-MHz antennas have no steering possibilities. The temperature distribution of the hot water balloon is not affected by inhomogeneous dielectric properties, only slightly by inhomogeneous perfusion. CONCLUSION: A hot water balloon is useful for heating tumours with a limited infiltration in tissue, while a 27-MHz device has the best potential to realize a homogeneous temperature distribution in larger tumours.

Hyperthermia treatment for malignant brain tumors: nursing management during therapy.

Interstitial hyperthermia therapy, the application of heat to control or destroy tumor tissue, is under investigation as an adjuvant treatment for recurrent intracranial malignancies. A brief review of the biologic effects and detailed information of one technique used to treat brain tumors are presented. Management of patients receiving hyperthermia is both challenging and complex. Neuroscience nurses must become knowledgeable about this form of therapy as it is more widely used in brain tumor management.

Volumetric interstitial hyperthermia: role of the critical care nurse.

Although statistical survival of patients with malignant brain tumor is dismal and their care can be emotionally exhausting, it is hopeful and rewarding to the critical care nurse to participate in a clinical investigation that will improve the future of these patients. Each therapy cycle administered, each patient treated, and each family member is different; each is a challenge for the critical care nurse. The quality and success of a clinical investigation requires the commitment of many people working together in close team effort. With effective communication, insight, and cooperation the critical care nurse working in this research setting shares in the patient's and family's hope and determination for the future of improved medical and nursing management of malignant brain tumors.