Quemaduras graves relacionadas con la terapia inhalatoria con vahos / Severe burns related to steam inhalation therapy

INTRODUCCIÓN: Todavía se emplean vahos con agua caliente como tratamiento de procesos respiratorios banales, a pesar del riesgo de ocasionar quemaduras y de no haberse demostrado su efectividad. OBJETIVOS: Caracterizar los casos de quemaduras relacionadas con vahos (QRV) en una población de niños quemados con el objeto de formular criterios para su prevención. PACIENTES Y MÉTODOS: Revisión de pacientes ingresados por QRV en una unidad de quemados durante el periodo 2006-2012. Se analizó: epidemiología, clínica, gravedad y evolución. RESULTADOS: Ingresaron 530 pacientes quemados; 375 (70%) con escaldaduras y 15 con QRV (2,8% del total; 4% de las escaldaduras). Los vahos fueron indicados mayoritariamente para tratar episodios catarrales banales. La edad mediana fue 7 años (2,5 meses-14 anos). La superficie corporal quemada (SCQ) fue ≥ 10% en el 60% de los casos (SCQ máxima 22%). Las quemaduras afectaron al tronco, a los genitales y a las extremidades y solo en un caso afectó a la cara. La estancia media hospitalaria fue de 14 días (3-30 d). Cinco niños (33%) ingresaron en la UCIP, la mayoría (60%) menores de 3 años. Ocho casos (53%) requirieron intervención quirúrgica (injerto de piel). Un paciente de 12 años fue diagnosticado de tos ferina y otro de 2,5 años presentó un shock tóxico estafilocócico. No hubo fallecimientos. Todos los pacientes evolucionaron satisfactoriamente. CONCLUSIONES: Las QRV pueden ser graves y consumir importantes recursos. Los profesionales de la atención al niño, particularmente los pediatras, deben velar por su prevención, absteniéndose de indicar los vahos como tratamiento y educando a los padres para que no los utilicen por sí mismos

INTRODUCTION: Despite lack of proven effectiveness and its potential to cause severe burns, steam inhalation therapy (SIT) is still used as a treatment for benign respiratory conditions. OBJECTIVE: To characterize cases of burns related to steam inhalation therapy (BRSIT) in order to formulate appropriate preventive criteria. PATIENTS AND METHODS: A review was conducted on cases of BRSIT admitted to a Burns Unit between 2006 and 2012, analysing epidemiological data, clinical aspects, severity and course. RESULTS: A total of 530 patients were admitted; 375 (70%) with scalds, and 15 with BRSIT (2.8% of burns; 4% of scalds). SIT was indicated in most cases for mild upper airway infections. The median age of patients was 7 years (2.5 m-14 y). The burned area (BA) was ≥ 10% in 60% of cases (max. BA 22%). Injuries involved trunk, genital area, and extremities; only in one case was the face affected. The mean hospital length-of-stay was 14 days (3-30d). Five patients (33%) were admitted to the PICU, most of them (60%) younger than 3 years. Eight patients (53%) underwent surgical treatment (skin grafting). In a 12-year-old patient whooping cough was diagnosed in the Burns Unit, and a 2.5-year-old patient developed staphylococcal toxic shock syndrome. No patient died. The final course was satisfactory in all patients. CONCLUSIONS: BRSIT can be severe and cause significant use of health resources. Professionals caring for children, particularly paediatricians, should seriously consider their prevention, avoiding treatments with SIT, and educating parents in order not to use it on their own

Knowledge of pediatricians in Rio de Janeiro, Brazil, about inhalation therapy in asthmatic children.

BACKGROUND: Despite the numerous guidelines on the diagnosis and treatment of asthma, there are data that indicate that general pediatrician's knowledge of the disease and its preferred treatment is limited, which may influence the quality of care given to asthmatic children. The purpose of this study was to describe pediatrician's knowledge of spacers and of concepts of chilhood asthma, as well as their prescribing habits concerning inhalation therapy, in the public health system of the city of Rio de Janeiro. METHODS AND RESULTS: A descriptive cross-sectional study was performed in a sample of 72 pediatricians from the public health system of Rio de Janeiro. A questionnaire was used to assess prescriptions for spacers, the reasons whay spacers were not used, the models employed, classification of asthma according to clinical severity and symptom frequency, recommendation for the correct spacer volume according to age group, and the concept of asthma as an inflammatory disease. Seventy percent (51/72) of the physicians did not routinely prescribe the spacer. The reasons given were as follows: a) lack of spacer availability in the public health system in 55 % (28/51); b) high cost in 57 % (29/51); c) the complexity of their use in 35 % (18/51); d) unwillingness to use aerosol type medication in 15 % (8/51), and e)lack of knowledge of their function and utilization in 59 % (30/51). Of the 30 % (21/72) who reported they regularly and routinely prescribed the spacer in daily practice, 48 % (10/21) stated that this routine prescription, even when indicated, was below 25 % of what was expected and makeshift models were preferred by 24 % (5/21) of the pediatricians. Six percent of the pediatricians chose the appropriate spacer volume according to age group, 62.5 % (45/72) reported that they classified asthma according to severity, 16 % (7/45) gave the correct answers when classifying asthma according to national consensus, and 22 % (16/72) considered asthma to be an inflammatory disease. CONCLUSIONS: The results of this study suggest that pediatrician's knowledge of inhalation therapy with dosed aerosol spacers and of asthma-related concepts in the public health system in Rio de Janeiro is limited. This may restrict the quality of care given to the asthmatic children in the city and suggests the need for training programs for the management of asthmatic children.