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Vol. 31. Issue 3.
Pages 120-130 (July - September 2020)
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Vol. 31. Issue 3.
Pages 120-130 (July - September 2020)
Original article
Analysis of hypothermia through the acute phase in major burns patients: Nursing care
Análisis de la hipotermia durante la fase aguda del paciente gran quemado: cuidados enfermeros
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J.M. Alonso-Fernándeza,
Corresponding author
jmalonsof@gmail.com

Corresponding author.
, P. Lorente-Gonzálezb, L. Pérez-Munguíaa, A.M. Cartón-Manriquea, M.C. Peñas-Raigosob, T. Martín-Ferreiraa
a Unidad de Quemados, Hospital Universitario Río Hortega, Valladolid, Spain
b Bloque Quirúrgico, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Tables (5)
Table 1. Rewarming strategies in the acute phase in burns patients.
Table 2. Nursing process in temperature control in the acute phase of the major burns patient.
Table 3. Characteristics of burns patients and according to the presence of hypothermia or normothermia on admission and in the 72h of the acute phase.
Table 4. Statistical analysis of temperature on admission of burns patients by means of contingency tables.
Table 5. Analysis and contingency tables of factors related to the death of patients with thermal burns.
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Abstract

Major burns patients usually present hypothermia after suffering a thermal burn, due to exposure during the accident, cooling of the burn and transfer. There are methods of reheating to avoid this heat loss, where nursing care is key.

Objective

To analyse the constant temperature presented by large burns patients on admission to the Burns Unit and their progression over the first 72h.

Method

Retrospective cross-sectional descriptive observational study of patients with thermal burns affecting more than 15% of body surface area, from December 2010 to May 2018. By reviewing databases and clinical records, demographic data, qualitative variables (origin of burn, previous pathologies, mechanical ventilation and ABSI and BOBI scales) and quantitative variables (burn depth and extension, temperature at admission and taken every 8h for 72h). Absolute, relative frequencies and the statistics of the quantitative variables were analysed. The study was verified by statistical tests according to the variables and contingency tables. A logistic regression model was developed expressed in a ROC curve.

Results

Of the 57 patients included, 79.2% developed hypothermia on admission. They presented burns over 34.56%±16.64 of their body surface, with 28.04%±17.49 being deep burns. Mortality during the stay was 29.8%. The presence of hypothermia during the acute phase was statistically related to death during stay in the unit (p=0.033). It was observed that hypothermia is directly related to the extent of the burn (p=0.003).

Conclusions

Due to the presence of hypothermia on admission, and to the fact that the average temperature does not exceed 36°C until at least 16h after the burn, nurses must know and promptly administer adequate reheating measures to improve chances of survival in major burns.

Keywords:
Nursing
Burns
Hypothermia
Body temperature
Acute-phase reaction
Resumen

Los grandes quemados habitualmente presentan hipotermia tras sufrir una quemadura de origen térmico debido a la exposición durante el accidente, enfriamiento de la quemadura y el traslado. Existen métodos de recalentamiento para evitar esta pérdida de calor, donde los cuidados enfermeros son claves.

Objetivo

Analizar la constante temperatura que presentan los grandes quemados en la admisión en la unidad de quemados y su evolución durante las primeras 72horas.

Método

Estudio observacional descriptivo transversal retrospectivo en pacientes con quemaduras térmicas con criterios de gran quemado, desde diciembre de 2010 hasta mayo de 2018. Mediante revisión de bases de datos e historias clínicas se recogieron los datos demográficos, variables cualitativas (origen de la quemadura, enfermedades previas, ventilación mecánica y escalas ABSI y BOBI) y variables cuantitativas (extensión y profundidad de quemadura, temperatura al ingreso y cada 8horas hasta las 72horas). Se analizaron frecuencias absolutas, relativas y los estadísticos de las variables cuantitativas. Se comprobó mediante test estadísticos en función de las variables y tablas de contingencia. Se desarrolló un modelo de regresión logística expresado en una curva ROC.

Resultados

De los 57 pacientes incluidos el 79,2% mostró hipotermia al ingreso, con una temperatura media de 34,43±1,98°C. Presentaron quemaduras en el 34,56±16,64% de su superficie corporal, siendo quemadura profunda en el 28,04±17,49%. La mortalidad durante la estancia fue del 29,8%. La presencia de hipotermia durante la fase aguda se relacionó estadísticamente con el fallecimiento en estancia (p=0,033). Se observó que la hipotermia está directamente relacionada con la extensión de la quemadura (p=0,003).

Conclusiones

Debido a la presencia de hipotermia al ingreso, y a que la temperatura media no supera los 36°C en quemados hasta pasadas 16horas desde la quemadura, las enfermeras deben conocer y administrar tempranamente las medidas de recalentamiento adecuadas para mejorar la supervivencia en grandes quemados.

Palabras clave:
Enfermería
Quemaduras
Hipotermia
Temperatura corporal
Reacción de fase aguda

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