RESUMEN
BACKGROUND AND OBJECTIVES: Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD: After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O2 under the same flow (control group). RESULTS: No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS: The association of N2O was not effective in reducing opioid consumption during dressing changes.
JUSTIFICATIVA E OBJETIVOS: Os ferimentos térmicos e a manipulação das áreas lesadas são causas importantes de dor em pacientes vítimas de queimaduras, necessitando que estes pacientes sejam constantemente submetidos a anestesias gerais para a troca do curativo. O óxido nitroso (N2O) tem propriedades analgésicas e sedativas, sendo capaz de fácil utilização e de ampla disponibilidade. Com isto, objetivou-se avaliar o efeito analgésico da administração de N2O associado ao fentanil em pacientes queimados, durante a troca de curativo. MÉTODO: Após aprovação pela comissão de ética institucional, foram avaliados 15 pacientes adultos, vítimas de queimaduras com necessidade de troca diária de curativo. A analgesia do paciente foi controlada pelo uso de fentanil 0,0005% administrado por bomba de infusão sob demanda, intravenosa. De maneira aleatória, em um dos dias foi associada mistura de N2O a 65% em oxigênio (O2) sob máscara com fluxo de 10 L/min (grupo N2O) e no outro dia apenas O2 sob o mesmo fluxo (grupo controle). RESULTADOS: Não se observou diminuição significativa da dor no grupo N2O em relação ao grupo controle. A dor na EAV antes da troca do curativo foi de 4,07 e 3,4; respectivamente nos grupos N2O e controle. Quanto à dor ao término da troca de curativo, os pacientes do grupo N2O referiram dor intensidade 2,8; enquanto no grupo controle foi de 2,87. Não houve diferença significativa de consumo de fentanil em ambos os grupos. CONCLUSÕES: A associação de N2O não foi eficaz na redução no consumo de opióides durante a troca de curativos.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Vendajes , Quemaduras/terapia , Fentanilo/administración & dosificación , Óxido Nitroso/administración & dosificación , Oxígeno/administración & dosificación , Dolor/etiología , Dolor/tratamiento farmacológico , Quemaduras/complicaciones , Método Simple Ciego , Analgesia Controlada por el Paciente/métodos , Resultado del Tratamiento , Analgésicos Opioides , Persona de Mediana EdadRESUMEN
BACKGROUND AND OBJECTIVES: Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD: After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O2 under the same flow (control group). RESULTS: No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS: The association of N2O was not effective in reducing opioid consumption during dressing changes.
Asunto(s)
Vendajes , Quemaduras/terapia , Fentanilo/administración & dosificación , Óxido Nitroso/administración & dosificación , Adolescente , Adulto , Analgesia Controlada por el Paciente/métodos , Analgésicos Opioides , Quemaduras/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/administración & dosificación , Dolor/tratamiento farmacológico , Dolor/etiología , Método Simple Ciego , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD: After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O2 under the same flow (control group). RESULTS: No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS: The association of N2O was not effective in reducing opioid consumption during dressing changes.
RESUMEN
A bioanalytical method was developed and applied to quantify the free imipenem concentrations for pharmacokinetics and PK/PD correlation studies of the dose adjustments required to maintain antimicrobial effectiveness in pediatric burn patients. A reverse-phase Supelcosil LC18 column (250 x 4.6 mm 5 micra), binary mobile phase consisting of 0.01 M, pH 7.0 phosphate buffer and acetonitrile (99:1, v/v), flow rate of 0.8 mL/min, was applied. The method showed good absolute recovery (above 90%), good linearity (0.25-100.0 µg/mL, r2=0.999), good sensitivity (LLOQ: 0.25 µg/mL; LLOD: 0.12 µg/mL) and acceptable stability. Inter/intraday precision values were 7.3/5.9%, and mean accuracy was 92.9%. A bioanalytical method was applied to quantify free drug concentrations in children with burns. Six pediatric burn patients (median 7.0 years old, 27.5 kg), normal renal function, and 33% total burn surface area were prospectively investigated; inhalation injuries were present in 4/6 (67%) of the patients. Plasma monitoring and PK assessments were performed using a serial blood sample collection for each set, totaling 10 sets. The PK/PD target attained (40%T>MIC) for each minimum inhibitory concentration (MIC: 0.5, 1.0, 2.0, 4.0 mg/L) occurred at a percentage higher than 80% of the sets investigated and 100% after dose adjustment. In conclusion, the purification of plasma samples using an ultrafiltration technique followed by quantification of imipenem plasma measurements using the LC method is quite simple, useful, and requires small volumes for blood sampling. In addition, a small amount of plasma (0.25 mL) is needed to guarantee drug effectiveness in pediatric burn patients. There is also a low risk of neurotoxicity, which is important because pharmacokinetics are unpredictable in these critical patients with severe hospital infection. Finally, the PK/PD target was attained for imipenem in the control of sepsis in pediatric patients...
Desenvolveu-se e aplicou-se método bioanalítico para quantificar concentrações de imipenem livre para estudos de farmacocinética (PK) e de correlação PK/PD dos ajustes de dose requeridos para manter a efetividade antimicrobiana em pacientes pediátricos queimados. Utilizou-se coluna Supelcosil LC18 (250 x 4,6 mm 5 micra), fase móvel binária, consistindo de tampão fosfato 0,01M pH 7,0 e acetonitrila (99:1, v/v) e fluxo de 0,8 mL/min. O método mostrou boa recuperação absoluta (acima de 90%), boa linearidade (0,25-100,0 µg/mL, r2=0.999), boa sensibilidade (LLOQ: 0,25 µg/mL; LLOD: 0,12 µg/mL) e estabilidade aceitável. Os valores de precisão inter/intradia foram 7,3/5,9% e a exatidão média foi de 92,9%. O método bioanalítico foi aplicado para quantificar concentrações de fármaco livre em crianças com queimaduras, Seis pacientes pediátricos queimados (idade média de 7,0 anos, 27,5 kg), com função renal normal e 33% da superfície total queimada foram investigados prospectivamente. Lesões por inalação estavam presentes em 4/6 (67%) dos pacientes. O monitoramento plasmático e a as avaliações de PK foram efetuadas utilizando coleção de amostras seriais de sangue para cada série, totalizando 10 conjuntos. O alvo PK/PD alcançado (40%T>MIC) para cada concentração inibitória mínima (MIC: 0,5, 1,0, 2,0, 4,0 mg/L) ocorreu em porcentagem maior do que 80% dos conjuntos investigados e 100% após o ajuste de dose. Em conclusão, a purificação das amostras do plasma usando técnica de ultrafiltração seguida de quantificação das medidas do imipenem no plasma usando método de cromatografia líquida é bastante simples, útil e necessita de pequenos volumes para as amostras de sangue. Além disso, pequena quantidade de plasma (0,25 mL) é necessário para garantir a efetividade do fármaco nos pacientes pediátricos queimados. Há, ainda, baixo risco de neurotoxicidade, o que é importante, visto que as farmacocinéticas são imprevisíveis nesses pacientes...
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Cromatografía Liquida/métodos , Imipenem/análisis , Imipenem/sangre , Pruebas de Química Clínica/métodos , Antibacterianos/farmacocinética , Antibacterianos/farmacología , Unidades de QuemadosRESUMEN
Introdução: A reconstrução do complexo areolomamilar é a fase final da reconstrução mamária. As técnicas de reconstrução do mamilo mais utilizadas são com retalhos locais ou enxertos. A utilização destas técnicas em mamas que sofreram queimaduras apresenta resultados indesejados, em decorrência da menor vascularização da pele lesada. O objetivo deste trabalho foi avaliar a utilização do retalho trilobado autonomizado na reconstrução do mamilo em mamas queimadas. Métodos: Oito pacientes do sexo feminino tiveram seus mamilos reconstruídas em dois tempos cirúrgicos. Resultados: Não ocorreram complicações, como necrose, deiscência, perda completa da projeção do novo mamilo ou infecção. A projeção média ao término da cirurgia foi de 15,25 mm e, após seis meses de reconstrução, foi de 3 mm, permanecendo estável. Todas as pacientes ficaram satisfeitas com os resultados. Conclusão: Concluímos que a autonomização deu segurança à reconstrução do mamilo em mamas queimadas e manteve projeção mínima satisfatória do mamilo reconstruído.
Introduction: Reconstruction of the nipple-areola complex is the final stage of breast reconstruction. The most common nipple reconstruction techniques use local flaps or grafts. However, these techniques in cases of burns produce undesirable outcomes due to the decreased vascularization of damaged skin. The objective of this work was to evaluate the use of the autonomized star flap in the nipple reconstruction of burned breasts. Methods: Nipples were reconstructed in eight female patients in two surgeries each. Results: There were no complications such as necrosis, dehiscence, complete loss of projection of the new nipple, or infection. The mean projection at the end of surgery was 15.25 mm; 6 months after reconstruction, it was 3 mm, showing stability. All patients were satisfied with their results. Conclusion: We conclude that autonomization leads to safe reconstruction of the nipple on burned breasts and maintains a satisfactory minimal projection of the reconstructed nipple.
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Humanos , Femenino , Adulto , Historia del Siglo XXI , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Trasplante , Mama , Mamoplastia , Procedimientos de Cirugía Plástica , Estudio de Evaluación , Glándulas Mamarias Humanas , Necrosis , Pezones , Complicaciones Posoperatorias/cirugía , Colgajos Quirúrgicos/cirugía , Trasplante/métodos , Mama/cirugía , Mamoplastia/métodos , Procedimientos de Cirugía Plástica/métodos , Glándulas Mamarias Humanas/cirugía , Necrosis/cirugía , Necrosis/complicaciones , Necrosis/terapia , Pezones/cirugíaRESUMEN
INTRODUCTION: To characterize the evolution of clinical and physiological variables in severe adult burn patients admitted to a Brazilian burn ICU, we hypothesized that characteristics of survivors are different from non-survivors after ICU admission. METHODS: A five-year observational study was carried out. The clinical characteristics, physiological variables, and outcomes were collected during this period. RESULTS: A total of 163 patients required ICU support and were analyzed. Median age was 34 [25,47] years. Total burn surface area (TBSA) was 29 [18,43]%, and hospital mortality rate was 42%. Lethal burn area at which fifty percent of patients died (LA50%) was 36.5%. Median SAPS3 was 41 [34,54]. Factors associated with hospital mortality were analyzed in three steps, the first incorporated ICU admission data, the second incorporated first day ICU data, and the third incorporated data from the first week of an ICU stay. We found a significant association between hospital mortality and SAPS3 [OR(95%CI)=1.114(1.062-1.168)], TBSA [OR(95%CI)=1.043(1.010-1.076)], suicide attempts [OR(95%CI)=8.126(2.284-28.907)], and cumulative fluid balance per liter within the first week [OR(95%CI)=1.090(1.030-1.154)]. Inhalation injury was present in 45% of patients, and it was not significantly associated with hospital mortality. CONCLUSIONS: In this study of an ICU in a developing country, the mortality rate of critically ill burn patients was high and the TBSA was an independent risk factor for death. SAPS3 at admission and cumulative fluid balance in the first seven days, were also associated with unfavorable outcomes. The implementation of judicious fluid management after an acute resuscitation phase may help to improve outcomes in this scenario.
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Quemaduras/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Adulto , Anciano , Brasil/epidemiología , Quemaduras/patología , Quemaduras/fisiopatología , Enfermedad Crítica , Femenino , Indicadores de Salud , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Equilibrio Hidroelectrolítico/fisiologíaRESUMEN
INTRODUÇÃO: O objetivo deste estudo é descrever a experiência da Unidade de Tratamento de Queimados da Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), em 15 meses consecutivos, no atendimento às crianças queimadas. MÉTODO: Foram analisados os dados de 98 pacientes, com idade < 13 anos, atendidos na Unidade de Tratamento de Queimados do HCFMUSP, de outubro de 2009 a dezembro de 2010. RESULTADOS: A média de idade das crianças atendidas foi de 5,2 anos, sendo 67 (68,4%) do sexo masculino. Os acidentes foram responsáveis por 93 (94,9%) casos, enquanto em 1 (1%) caso ocorreu agressão. Observou-se maior ocorrência de queimaduras em crianças com até 2 anos de idade. O principal agente da queimadura foi escaldadura (48%), seguido de fogo (17%) e sólido aquecido (17%). A média da superfície corpórea queimada de 2º e 3º graus foi de 10%. Seis (6,1%) pacientes apresentaram > 20% da superfície corpórea queimada, 5 (83,3%) deles por combustão de álcool e 1 (16,7%) por escaldo com água. Entre os 3 casos em que a superfície corpórea queimada de 2º e 3º graus foi > 30%, todos ocorreram por combustão de álcool. CONCLUSÕES: O levantamento demonstra a importância da queimadura em pacientes da faixa etária pediátrica. O conjunto de dados obtidos permite inferir que os esforços de prevenção devem se concentrar no ambiente doméstico, contra a possibilidade de ocorrência de escaldaduras nas crianças com < 5 anos de idade. A partir dos 5 anos, as campanhas devem abordar tanto o ambiente doméstico como o extradoméstico.
BACKGROUND: This study describes the experience with the care of burned children in the Burn Treatment Unit, Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Hospital of the Faculty of Medicine, University of São Paulo - HCFMUSP) over 15 consecutive months. METHODS: The data of 98 patients up to 13 years of age treated in the Burn Treatment Unit of HCFMUSP from October 2009 to December 2010 were analyzed. RESULTS: The average age of the children was 5.2 years; 67 (68.4%) were boys. Accidents were responsible for burns in 93 (94.9%) cases, whereas 1 (1%) case of burns was caused by aggression. There was a higher incidence of burns in children under 2 years of age. The main agent causing burns was hot liquids (48%), followed by fire (17%) and hot solids (17%). The mean body surface area affected by second- and third-degree burns was 10%. Six (6.1%) patients had burns over more than 20% of their body surface area - 5 (83.3%) of them had burns due to burning alcohol and 1 (16.7%) due to scalding water. All cases in which more than 30% of the body surface was affected by second- and third-degree burns were due to alcohol burns. CONCLUSIONS: This survey demonstrates the importance of burn injuries in pediatric patients. The dataset suggests prevention efforts should focus on the domestic environment, particularly against scalding in children less than 5 years of age. In children older than 5 years, prevention programs should focus on both domestic and extradomestic environments.
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Niño , Adolescente , Prevención de Accidentes , Quemaduras , Quemaduras Químicas , Quemaduras por Electricidad , Estudios Epidemiológicos , Niño , Epidemiología , Métodos , PacientesAsunto(s)
Antifúngicos/sangre , Quemaduras/sangre , Fluconazol/sangre , Micosis/prevención & control , Adulto , Antifúngicos/administración & dosificación , Quemaduras/tratamiento farmacológico , Quemaduras/microbiología , Cromatografía Líquida de Alta Presión , Monitoreo de Drogas/métodos , Fluconazol/administración & dosificación , Humanos , Reproducibilidad de los ResultadosAsunto(s)
Adulto , Humanos , Antifúngicos/sangre , Quemaduras/sangre , Fluconazol/sangre , Micosis/prevención & control , Antifúngicos/administración & dosificación , Quemaduras/tratamiento farmacológico , Quemaduras/microbiología , Cromatografía Líquida de Alta Presión , Monitoreo de Drogas/métodos , Fluconazol/administración & dosificación , Reproducibilidad de los ResultadosRESUMEN
Introdução: Para o adequado estudo anatomopatológico dos tecidos obtidos dos pacientes é crucial a boa técnica para a melhor evidenciação das células pesquisadas. É imprescindível que não só a técnica ideal de coloração/marcação seja utilizada, mas também a correta técnica de fixação da peça cirúrgica. Em trabalho prévio pesquisando miofibroblastos e contração na pele restaurada de áreas doadoras de enxertos de pele de espessura parcial, verificamos baixa densidade de miofibroblastos, ao contrário dos estudos em tecido de granulação. Investigando as causas disso, e baseando-se em artigo específico sobre a eficácia da evidenciação imuno-histoquímica com diferentes métodos de fixação tecidual, comparamos a eficácia dos diferentes fixadores, formol a 10% e álcool a 70% para a evidenciação de miofibroblastos em tecido de granulação de úlceras crônicas de 21 pacientes. Método: Estudamos 42 amostras por meio de técnica imuno-histoquímica, utilizando-se o anticorpo anti-Smooth Muscle Actin, nas quais contamos os miofibrobastos em 10 campos com aumento de 400 X. Resultados: Demonstraram-se melhores resultados qualitativo e quantitativo no material fixado em álcool, quando comparado ao fixado em formol, com densidades médias de miofibroblastos de 86,5 e 48 células/mm2, respectivamente, o que nos leva a recomendar o álcool como fixador de tecidos para estas análises imuno-histoquímicas.
Background: The use of a good visualization technique is crucial for an adequate pathological anatomy study of tissues obtained from patients. Optimal staining and fixation techniques of the surgical piece are essential. In a previous study investigating myofibroblasts and contraction in split skingraft donor sites, a low density of myofibroblasts was observed, as opposed to studies in granulation studies. To investigate the causes for this finding and based on a specific manuscript on the efficacy of immunohistochemical visualization using different tissue fixation methods, we compared the efficacy of fixation in 10% formaldehyde and 70% alcohol for the visualization of myofibroblasts in granulation tissues of chronic ulcers in 21 patients. Method: Forty-two samples were studied by immunohistochemistry, using the anti-Smooth Muscle Actin antibody, and myofibroblasts were counted in 10 fields with a magnification of 400X. Results: Better qualitative and quantitative results were observed in alcohol-fixed materials, when compared to those fixed in formaldehyde, with mean myofibroblasts densities of 86.5 and 48 cells/mm2, respectively, which encourages us to recommend the use of alcohol for tissue fixation in immunohistochemical studies.