Determinando el pronóstico del paciente gran quemado: correlación del Índice de Garcés con el Abbreviated Burn Severity Index (ABSI) / Defining the prognosis of the burned patient: correlation of the Garces Index with the Abbreviated Burn Severity Index (ABSI)

Resumen Introducción: Existen distintos scores pronósticos para determinar probabilidad de muerte en pacientes quemados. El Índice de Garcés (IG) utilizado en Chile, no es aceptado mundialmente. Objetivo: Decidimos evaluar la correlación entre IG y Abbreviated Burn Severity Index (ABSI), de uso generalizado. Materiales y Método Estudio descriptivo analítico transversal de pacientes quemados subidos a la plataforma online "Registro Nacional de Quemados" y luego ingresados a nuestro centro entre julio de 2017 y julio de 2018. Se calculó coeficiente de correlación de Pearson entre IG y ABSI. Se normalizan ambas variables para hacerlas comparables y se calculó concordancia entre estas con coeficiente de correlación de Lin. Con análisis de regresión logística se calculó probabilidad de fallecer asociada para ambas variables y se compararon áreas de las curvas ROC de ambos scores. Resultados: De 141 pacientes, 15 fallecieron durante hospitalización, con medias de IG de 104 ± 49 puntos y ABSI 7 ± 2. El coeficiente de correlación de Pearson entre IG y ABSI demostró ser muy alto con un valor de 0,928. El coeficiente de correlación de Lin entregó concordancia moderada con un valor de 0,93. Al comprobar cuál de las dos puntuaciones predice mejor la probabilidad de muerte mediante análisis de sensibilidad y especificidad, la curva ROC cubre más área en IG (0,82 vs. 0,83), sin ser estadísticamente significativo. Conclusiones: Ambos índices, IG y ABSI, son muy similares para predecir la probabilidad de muerte, por lo cual son equiparables a la hora de compartir resultados de estudios científicos.

Introduction: There are different prognostic scores to determine the probability of death in burned patients. The Garces Index (GI) used in Chile is not accepted worldwide. Aim: We decided to evaluate the correlation between IG and Abbreviated Burn Severity Index (ABSI), which is widely used. Materials and Method: Cross-sectional analytical and descriptive study of burned patients uploaded to the online platform "National Burns Registry" and then admitted to our center between July 2017 and July 2018. Pearson's correlation coefficient between IG and ABSI was calculated. Both variables were normalized to be able to make them comparable and the agreement between them was calculated with Lin's correlation coefficient. With logistic regression analysis, the associated probability of death was calculated for both variables and areas of the ROC curves of both scores were compared. Results: Of 141 patients, 15 died during hospitalization, with a mean GI 104 ± 49 and ABSI 7 ± 2. Pearson's correlation coefficient between GI and ABSI showed a very high correlation with a value of 0.928. Lin's correlation coefficient gave moderate agreement with a value of 0.93. When checking which of the two scores best predicts the probability of death through sensitivity and specificity analysis, the ROC curve covers more area in IG (0.82 vs 0.83) without being statistically significant. Conclusions: Both scores, IG and ABSI, are very similar when it comes to predicting the probability of death, which is why they are comparable at the time of sharing the results in scientific studies.

Research progress of surgical smoke / 国际外科学杂志

Surgical smoke is a by-product of aerosol produced by electrosurgical equipment, laser and other energy equipments when cuting tissue or coagulating blood vessels. It contains non-active particles, organic chemicals, pathogens, viable cells and so on. The characteristics of surgical smoke components produced by different types of tissues or using different kinds of energy devices are different. For example, the average diameter of smoke particles produced by electrocautery is smaller, the possibility of viable cells and pathogens in surgical smoke produced by ultrasonic knife is higher. According to the characteristics of its composition, surgical smoke may be an imporant risk factor to the health and safety of operating room staff and patients. The use of surgical masks, suction devices and portable smoke evacuation systems can reduce the risk to some extent. But the most operating room staff don′t take corresponding measures to protect them. In this paper, the characteristics of surgical smoke and the research progress of protective measures will be briefly reviewed.

Associação entre proteína 1 relacionada à uteroglobulina e gravidade da lesão por inalação de fumaça / Association of uteroglobin-related protein 1 with smoke inhalation injury severity

RESUMO Objetivo: Avaliar a expressão sérica da proteína 1 relacionada à uteroglobulina na fase inicial após lesões por inalação de fumaça e sua associação com a gravidade da lesão por inalação em pacientes queimados. Métodos: A lesão por inalação de fumaça ou produtos químicos se associa com morbidade e mortalidade. As consequências da inalação resultam de uma resposta inflamatória. A proteína 1 relacionada à uteroglobulina é anti-inflamatória e pode melhorar a inflamação pulmonar. Nossa hipótese é que os níveis de proteína 1 relacionada à uteroglobulina podem refletir a gravidade da doença e predizer o desfecho em pacientes com lesão por inalação. Incluíram-se prospectivamente neste estudo 16 pacientes com diagnóstico de síndrome do desconforto respiratório agudo decorrente de lesão por inalação de fumaça. Em todos os pacientes, colheu-se amostra de plasma quando da admissão à unidade de terapia intensiva, para avaliar a gravidade da lesão por inalação dentro de 72 horas. Os níveis plasmáticos de proteína 1 relacionada à uteroglobulina foram determinados em duplicata por meio de ensaio de imunoabsorção ligado à enzima. Resultados: A média de idade foi de 23 ± 5 anos, e a distribuição da lesão por inalação foi: três em grau 1, quatro em grau 2 e nove em grau 3. O nível de proteína 1 relacionada à uteroglobulina foi relacionado ao grau de severidade (grau 1: 0,389 ± 0,053 unidade arbitrária versus grau 2: 0,474 ± 0,0423 unidade arbitrária versus grau 3: 0,580 ± 0,094 unidade arbitrária; p = 0,007). Conclusão: Os níveis plasmáticos de proteína 1 relacionada à uteroglobulina se associam com o grau da lesão pulmonar por inalação.

ABSTRACT Objective: To evaluate serum uteroglobin-related protein 1 expression early after smoke inhalation injuries and its association with the severity of inhalation injury in burned patients. Methods: Smoke or chemical inhalation injury is associated with morbidity and mortality. The consequences of inhalation result from an inflammatory response. Uteroglobin-related protein 1 is an anti-inflammatory protein and may improve lung inflammation. We hypothesized that uteroglobin-related protein 1 levels could reflect disease severity and predict outcome in patients with inhalation injury. Sixteen patients diagnosed with acute respiratory distress syndrome secondary to smoke inhalation injury were prospectively included in the study. Plasma was collected upon intensive care unit admission and within 24 hours of the inhalation injury. Bronchoscopies were carried out in all patients to assess the severity of inhalation injury within 72 hours. Uteroglobin-related protein 1 plasma levels were determined in duplicate with enzyme-linked immunosorbent assay. Results: The mean age was 23 ± 5 years, and the inhalation injury distribution was as follows: three of grade 1, four of grade 2, and nine of grade 3. The level of uteroglobin-related protein 1 was related to inhalation severity (grade 1: 0.389 ± 0.053 arbitrary units versus grade 2: 0.474 ± 0.0423 arbitrary units versus grade 3: 0.580 ± 0.094 arbitrary units; p = 0.007). Conclusion: Plasma levels of uteroglobin-related protein 1 are associated with the degree of lung inhalation injury.

Comparative Study of Protective Effects of Atomization Inhalation and Intraperitoneal Injection of Edaravone on Smoke Inhalation Lung Injury Model Rats / 中国药房

OBJECTIVE：To compare the protective effect of atomization inhalation and intraperitoneal injection of edaravone on acute lung injury in smoke inhalation lung injury model rats. METHODS ：Thirty male SD rats were divided into normal control group（group A ），injury group （group B ），intraperitoneal injection group （group C ），low-dose aerosol inhalation group （group D），high-dose aerosol inhalation group （group E ）according to random numble table ，with 6 rats in each group. Group B-E were placed in smoke generator containing pine sawdust to induce smoke inhalation lung injury model. In group A ，the operation was the same as above except that the pine sawdust was not placed. Thirty minutes after modeling ，group C were injected intraperitoneally with edaravone 18 mg/kg（every 70 min，4 times in total ）. Group D and E inhaled edaravone 9，1.8 mg/kg（every 60 min，lasting for 10 min each time ，4 times in total ）. The rats were treated by no means in group A and group B. Six hours after last medication，arterial blood gas analysis was performed ，and the lung wet to dry ratio （W/D）and water content of lung tissue were calculated. The levels of TNF-α，IL-6 and IL- 10 in serum were detected by double antibody ELISA. The contents of MDA ，MPO， SOD and Caspase- 3 in lung tissue were determined by ELISA and other methods. HE staining was used to observe the pathological changes of lung tissue. The apoptotic rate of cells in lung tissue were determined by TUNEL assay. RESULTS ：No abnormality was found in lung tissue of group A ；in group B ，hemorrhage and edema were found in lung tissue ，alveolar structure was difficult to identify，and inflammatory cells and red blood cell infiltration were seen. Above symptoms of rats in group C-E were improved to different extent. Compared with group A ，PaO2/FiO2 and SOD content of lung tissue were decreased significantly in other groups （P＜0.05）；water content of lung tissue ，W/D，serum contents of TNF-α，IL-6 and IL- 10，the contents of MDA ，MPO and Caspase-3 in lung tissue ，apoptotic rate were increased significantly （P＜0.05）. Compared with group B ，PaO2/FiO2 and serum contents of IL- 10 were increased significantly in administration groups （P＜0.05）；water content of lung tissue ，W/D，serum contents of TNF-α and IL-6，the contents of MDA ，MPO and Caspase- 3 in lung tissue ，apoptotic rate were significantly decreased，in dose-dependent manner （P＜0.05）. CONCLUSIONS ：Edaravone has a certain protective effect on smoke inhalation lung injury model rat. It can reduce the production and release of inflammatory mediators and/or cytokines ，reduce the peroxide damage and inhibit cell apoptosis in a dose-dependent manner. The effect of atomization inhalation is more obvious than that of intraperitoneal injection.

Effect of different concentrations of moxa smoke exposure on nasal mucosal injury and expression of serum IL-1, IL-6 and TNF-α in rats / 中国针灸

OBJECTIVE@#To observe the effect of long-term moxa smoke exposure of different concentrations on olfactory function in rats, and provide experimental basis of safety study of moxa smoke produced by moxibustion.@*METHODS@#Forty SD rats were randomly divided into a normal control group, a low-concentration moxa smoke group, a moderate-concentration moxa smoke group and a high-concentration moxa smoke group, 10 rats in each one. The rats in the moxa smoke groups were put into three plexiglass moxibustion boxes with different moxa smoke concentrations, 4 hours per times, twice a day for 90 days. The general state of rats was evaluated before and during the experiment. After the intervention, the olfactory function was evaluated by two-bottle experiment (TBE); the morphology of nasal mucosa was observed by HE staining; the apoptosis of olfactory epithelial cells in nasal mucosa was detected by TUNEL method; the serum levels of interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by ELISA method.@*RESULTS@#In the late stage of moxa smoke exposure (45-90 days into intervention), the behavioral activity of rats in the moderate-concentration moxa smoke group and the high-concentration moxa smoke group was weaker than that in the normal control group, and their response to stimulation was strong, and their mental state was worse. After intervention, the drinking rate of vinegar-water mixture in the moderate-concentration moxa smoke group and the high-concentration moxa smoke group was higher than that in the normal control group and the low-concentration moxa smoke group (@*CONCLUSION@#The long-term exposure to low, moderate and high concentrations of moxa smoke could cause pathological changes in nasal mucosa and increase the serum levels of IL-1, IL-6 and TNF-α; the moderate and high concentrations of moxa smoke exposure could cause a series of damage to olfactory function and reduce olfactory sensitivity in rats.

Principais complicações respiratórias no adulto queimado internado em um hospital de referência do estado de Minas Gerais / Main respiratory complications in burned adult in a reference hospital of Minas Gerais State / Principales complicaciones respiratorias de los adultos quemados admitidos a un hospital de referencia del estado de Minas Gerais

OBJETIVO: Descrever as principais complicações respiratórias do adulto queimado admitido em um centro de terapia intensiva de um hospital de referência do estado de Minas Gerais. MÉTODO: Estudo transversal, no qual foram incluídos todos os pacientes admitidos no setor de terapia intensiva da Unidade de Tratamento de Queimados de 1º de janeiro a 30 de junho de 2017 deste hospital. Os dados coletados foram submetidos à análise estatística com o uso do software Microsoft® Office Excel 2010 e pelo Minitab® versão 18. O estudo foi aprovado no Comitê de Ética em Pesquisa da Instituição, com parecer número 2.698.566. RESULTADOS: Foram analisados 62 registros de pacientes, a maioria do sexo masculino (64,52%, n=40). A média de idade dos pacientes foi de 43,90±16,57 anos, sendo a faixa etária mais prevalente entre 18 e 34 anos (35,48%, n=22). A maior parte dos pacientes necessitou de suporte avançado de vida, sendo que 74,20% (n=46) foram submetidos à intubação orotraqueal e, destes, 50% (n=23) foram traqueostomizados posteriormente. As complicações respiratórias foram observadas em 51,61% (n=32), sendo as principais: pneumonia (25,81%, n=16), lesão de via aérea (24,19%, n=15), atelectasia (17,74%, n=11), congestão pulmonar (12,90%, n=8) e síndrome do desconforto respiratório agudo (8,06%, n=5). CONCLUSÃO: As principais complicações respiratórias foram pneumonia e lesão de via aérea. Tais complicações contribuíram para maior tempo de internação hospitalar e de ventilação mecânica.

Objective: To describe main pulmonary complications in burned adults admitted to intensive care unit of a burn center of Minas Gerais State. METHODS: Cross-sectional study, which included all patients admitted to the intensive care unit of a burn unit, from January, 1st until June, 30th. Collected data were submitted to statistical analyzes using software Microsoft® Excel 2010 and Minitab® version 18. The study was approved by Research Ethics Committee of the institution, with opinion number 2698566. RESULTS: 62 patients records were analyzed, most male (64.52%, n=40), mean age of patients was 43.90±16.57 years, being most prevalent age group between 18 and 34 years (35.48%, n=22). Most patients needed advanced life support, 74.20% (n=46) used endotracheal tube and, of these, 50% (n=23) were tracheostomized later. Pulmonary complications were observed in 51.61% (n=32), and the main ones were: pneumonia (25.81%, n=16), airway injury (24.19%, n=15), atelectasis (17.74%, n=11), pulmonary congestion (12,90%, n=8) and acute respiratory distress syndrome (8.06%, n=5). CONCLUSION: Main pulmonary complications were pneumonia and airway injury. Such complications have contributed to increase time of hospitalization and mechanical ventilation.

Objetivo: Describir las principales complicaciones respiratorias de los adultos quemados admitidos en el centro de cuidados intensivos de un hospital de referencia del estado de Minas Gerais. Método: Estudio transversal, que incluyó a todos los pacientes ingresados en el sector de cuidados intensivos de la Unidad de Quemados de este hospital, del 1º enero hasta 30 junio de 2017. Los datos recolectados fueron sometidos al análisis estadístico utilizando los programas Microsoft® Office Excel 2010 y por Minitab® versión 18. El estudio fue aprobado por el Comité de Ética de Investigación de la institución - dictamen nº 2.698.566. Resultados: 62 pacientes participaron del estudio, en su mayoría hombres (64,52%, n=40), con media de edad de 43,90±16.57 años, siendo más prevalente el grupo de edad comprendido entre 18 y 34 años (35,48%, n=22). La mayoría de los pacientes necesitó apoyo vital avanzado, conun 74,20% (n=46) sometidos a intubación orotraqueal y, de estos, 50% (n=23) fueron traqueostomizados posteriormente. Se observaron complicaciones respiratorias en un 51,61% (n=32) de los pacientes, siendo las principales: neumonía (25,81%, n=16), lesiones de las vías respiratorias (24,19%, n=15), atelectasia (17,74%, n=11), congestión pulmonar (12,90%, n= 8) y síndrome de dificultad respiratoria aguda (8,06%, n=5). Conclusión: Las principales complicationes respiratorias fueron neumonía y lesiones de las vías respiratorias. Tales complicaciones han contribuido a estancias más largas en el hospital y utilización de ventilación mecánica.

Bone marrow mesenchymal stem cells protect lungs from smoke inhalation injury by differentiating into alveolar epithelial cells via Notch signaling

To examine the protective effect of transplanting bone marrow mesenchymal stem cells (BMSCs) in treating lung injuryinduced by smoke exposure and to investigate the underlying mechanisms of this protection. SD rats were randomlydivided into four groups: normal group, normal ? BMSCGFP group, smoke group, and smoke ? BMSCGFP group. Todetect lung injury, we measured arterial blood gas, the wet-to-dry weight ratio, and levels of interleukin-1b, tumor necrosisfactor-a, interleukin-10, and interleukin-13 in bronchoalveolar lavage fluid and lung tissues. We also conductedhistopathology examinations. The protein markers of alveolar epithelial cells were measured to determine the BMSCdifferentiation. The protein levels of Notch1, Jagged-1, and Hes-1 also were detected. In the present study, BMSCtransplantation significantly decreased the wet-dry weight ratio of the lung, reduced the production of inflammatorymediators, and alleviated lung injury simply through differentiating into alveolar type II cells and alveolar type I cells.Western blot analysis confirmed that the protein expression of Notch-1, Jagged-1, and Hes-1 increased significantly aftersystemic BMSC transplantation. No significant difference was observed between the normal group and the normal ? BMSCGFP group. Our findings indicate that systemic transplantation of BMSCs alleviated lung injury induced bysmoke exposure, which may be associated with BMSCs’ ability to differentiate into alveolar-type cells via the Notchsignaling pathway.

The impact of glucocorticoid on coagulation of smoke inhalation induced lung injury / 中华急诊医学杂志

Objective To explore the impact of glucocorticoid on coagulation through administrating on rats with smoke inhalation.Methods Totally 150 male S-D rats were randomly (random number) divided into 5 groups:control group (ambient air inhalation),smoke group (smoke inhalation for 30 min),smoke+high dosage methyl prednisolone group(MP 40 mg/kg,intraperitoneal injection,s+HMP group),smoke+medium dosage MP (4 mg/kg) group (s+MMP group),smoke+low dosage MP (0.4 mg/kg) group (s+LMP group) (all n=30).Survival rates were calculated 24 h after smoke inhalation.Lung tissues were collected for histopathology and wet to dry (W/D) ratio.Arterial blood was collected for blood gas test.Coagulation factors in lung and plasma were tested.Results Survival rates of three MP groups were markedly improved compared with the smoke group (all P＜0.05),and was significantly higher in the medium dosage group(85.17％) than those in the low and high dosage groups (65.73％ and 60.07％,all P＜0.05).The W/D ratio and blood gas test were markedly improved in the high and medium groups (all P＜0.05).Tissue factor (TF) and thrombin-antithrombin complex (TAT-c) in bronchoalveolar lavage fluid (BALF) increased dramatically after SI (P＜0.01,P=0.005) with a remarkable drop of factor Ⅱ (F Ⅱ) (P=0.007),all of which were attenuated by MP with dosage dependence.The mRNA expression of TF increased dramatically after SI and recovered significantly with MP administration,while the expression of thrombomodulin (TM) recovered in the opposite direction with MP,all of which were in a dosage dependent manner.TF,fibrinogen (FIB),TAT-c increased significantly in plasma after smoke inhalation (P＜0.01,P=0.027,P=0.005).F Ⅷ ％ increased with MP administration and TF was raised by high dosage MP compared with the smoke group.FIB and TAT-c were decreased in all MP groups,which were significant higher in the high and middle dosage groups.The change of TM and endothelial cell protein C receptor (EPCR) in circulation were similar with FIB or TAT-c with or without MP.Protein C (PC％) and antithrombin (AT Ⅲ ％) dropped dramatically after SI,high and middle dosages of MP could restore the activity significantly,while low dosage would restore AT Ⅲ ％ but not PC％.Conclusions Glucocorticoid can significantly improve local and systemical coagulation disorder caused by smoke inhalation,and high-and medium-dosage hormones are effective.The regulation of hormones on the coagulation system is an important mechanism in the treatment of smoke inhalation induced lung injury.

Therapeutic effects of different doses of methylprednisolone on smoke inhalation-induced acute lung injury in rats / 中华危重病急救医学

Objective To investigate the therapeutic effect of different doses of methylprednisolone (MP) in smoke inhalation-induced acute lung injury (SI-ALI).Methods Adult male Sprague-Dawley (SD) rats were divided into control group (group A,n = 6), smoke inhalation group (group B, smoke inhalation 30 minutes,n = 30) and smoke+MP 40, 4, 0.4 mg/kg intervention group (groups C, D, E; intraperitoneal injection of MP at 1 hour before smoke inhalation, n = 30) according to random number table method. The survival status of rats in each group was observed at 24 hours, and murine smoke inhalation induced trauma score (MSITS) according to the symptoms and signs of rats at 3 hours after smoke inhalation were scored. The blood of abdominal aorta of rats was collected. Then the rats were sacrificed to harvest bronchoalveolar lavage fluid (BALF) and lung tissue. The levels of interleukin (IL-6, IL-17a) in plasma and BALF were detected by enzyme linked immunosorbent assay (ELISA); the total number of white blood cells and the proportion of leukocytes or macrophages in BALF were calculated; the histopathological changes of lung were observed and the lung injury score was given; the expression of myeloperoxidase (MPO) and high mobility group protein B1 (HMGB1) in lung tissue were detected by Western Blot.Results The 24-hour survival rate of group B rats was 33.67％. The survivalrate of groups C, D and E (65.73％, 85.17％, 60.07％) were significantly higher than that of group B (allP < 0.05), and the survival rate of group D was significantly higher than that of groups C and E. Diffuse inflammatory cell infiltration, intra-alveolar hemorrhage and a large amount of edema fluid were seen in the lung tissue of group B; and the lung injury score was significantly higher than that of group A. Compared with group B, the lung injury in different doses of MP group were decreased to different degrees, while the lung injury scores in groups C and D were significantly decreased (3.31±1.37, 2.62±0.98 vs. 5.52±0.97, bothP < 0.01); correlation analysis showed that MSITS score was significantly and positively correlated with lung injury score (r = 0.862,P < 0.001). The levels of plasma inflammatory factors and BALF protein, inflammatory cells and inflammatory factors, and the expression of MPO, HMGB1 in group B were significantly higher than those in group A. Compared with group B, the levels of inflammatory factors in plasma, and protein content, inflammatory cells and inflammatory factors in BALF in different doses of MP group were decreased to different degrees, with significant differences in groups C and D [plasma: IL-17a (pg/L): 49.28±27.12, 36.57±16.52 vs. 191.79±88.21; IL-6 (ng/L): 206.47±109.96, 197.52±113.86 vs. 669.00±299.60; BALF: protein content (mg/L):892.0±164.5, 566.1±120.9 vs. 1838.0±145.8; white blood cell count (×109/L): 5.40±1.67, 2.81±1.20 vs. 9.02± 2.06; neutrophil ratio: 0.315±0.081, 0.273±0.080 vs. 0.590±0.096; IL-17a (ng/L): 22.63±8.62, 18.92±8.43 vs. 43.31±19.17; IL-6 (ng/L): 156.49±46.94, 123.66±64.91 vs. 253.43±80.03; allP< 0.01]; in addition, the expression of MPO and HMGB1 protein in lung tissues of MP groups with different doses were significantly decreased, the expression of MPO in group D was significantly lower than that in group E [MPO/β-actin (fold increase from group A):2.14±0.97 vs. 4.35±0.87,P < 0.01], the expression of HMGB1 in groups C and D were significantly lower than that in group E [HMGB1/β-actin (fold increase from group A): 1.77±0.73, 1.23±0.67 vs. 3.65±1.08, bothP < 0.05]. Conclusions MP can significantly improve the survival rate of SI-ALI rats and reduce the acute pulmonary and systemic inflammatory response. The MP effect of 4 mg/kg was better than 40 mg/kg and 0.4 mg/kg.

Protective effects of bone marrow mesenchymal stem cell-derived exosomes on smoke inhalation injury in rats / 医学研究生学报

Objective Acute lung injury induced by variety causes can be reduced by mesenchymal stem cells.Some studies have shown that mesenchymal stem cell-derived exosomes have similar features with mesenchymal stem cell,but its role in acute lung injury is less studied.The study was to investigate the protective role and underlying mechanisms of bone marrow mesenchymal stem cell-derived exosomes (BMSC-DEs) on smoke inhalation injury (SⅡ) in rats.Methods Thirty Wistar rats were randomly divided into 3 equal groups:normal control group,smoke inhalation injury (SⅡ) model group and bone marrow mesenchymal stem cell-derived exosomes (BMSC-DEs) treated group.12 h after establishing the SⅡ model,BMSC-DEs treated group was injected with 0.5 mL BMSC-DEs (derived from 4× 106 BMSCs),and normal control group and SⅡ model group were injected with equivalent volume of normal saline.7 days later,samples were collected.The histopathologic changes of lung were observed after HE staining;BCA was used to test the amounts of total protein in bronchoalveolar lavage fluid (BALF);Enzyme linked immunosorbent assay was used to test the levels of tumor necrosis factor-α (TNF-α) and keratinocyte growth factor (KGF) in the lung tissue;Immunohistochemical was used to test the levels of pulmonary surfactant protein C(SP-C).Results The BALF levels of total protein of SⅡ group was significantly higher than those of normal control group (P＜0.01) and BMSC-DEs groups(P＜0.05);Compared with normal group [(0.164±0.021) ng/L],the levels of tumor necrosis factor-α of SII and BMSC-DEs groups [(0.355±0.106)、(0.234±0.024) ng/L] (P＜ 0.05) were significantly higher,and SⅡ group was higher than that of BMSC-DEs group(P＜0.01);Compared with normal group,the KGF protein expression level in lung tissue of SⅡ group was significantly lower (P＜0.05),but BMSC-DEs group was higher (P＜0.05).BMSC-DEs group was higher than SⅡ group (P＜0.01);Immunohistochemistry showed that the SP-C expression level in lung tissue of SⅡ group was significantly lower than those of other groups (P＜0.05).There was no statistically difference between BMSC-DEs group and control group (P＞0.05).Conclusion BMSC-DEs has a protective effect of smoke inhalation injury rats,the underlying mechanism may be related to BMSC-DEs to reduce inflammation and promote restoration of the alveolar epithelial type Ⅱ.

Clinical Curative Effects of High Frequency Oscillatory Ventilation on Acute Respiratory Distress Syndrome Caused by Smoke Inhalation Injury in the Lungs / 昆明医科大学学报

Objective To study the curative effect of high frequency oscillatory ventilation on acute respiratory distress syndrome (ARDS) caused by smoke inhalation injury in the lungs. Methods Fifty ARDS patients with lung injury caused by smoke inhalation were selected from 2010 to 2015. Patients were randomly divided into two groups, respectively choosing conventional mechanical ventilation or high frequency oscillatory ventilation. Results PaO2, PaCO2, and PaO2/FiO2were improved in both groups after the treatment (P＜0.05) . Patients in the treatment group improved significantly compared to those in the control group (P＜0.05) . The ventilation time and length of hospital stay reduced significantly in the treatment group (P＜0.05) . No significant difference was found in mortality and complication rates in both groups within 30 days (P＞ 0.05) . Conclusion High frequency oscillatory ventilation can effectively alleviate symptoms of ARDS caused by smoke inhalation injury in the lungs by improving oxygenation index. No obvious improvement is found in prognosis.

Acute clinical manifestations in toxic smoke inhalation victims: systematic review of observational studies / Manifestações clínicas agudas em vítimas de inalação de fumaça tóxica: revisão sistemática de estudos observacionais / Manifestaciones clínicas agudas en víctimas de inhalación de humos: revisión sistemática de estudios observacionales

Abstract Introduction: Lung injuries from toxic smoke inhalation are the main causes of death in fire victims; however, information regarding the acute effects on the respiratory system after smoke inhalation and its constituents in closed environments are still scarce in literature. Objective: To investigate the acute clinical manifestations observed in victims of smoke inhalation during enclosed-space fires by means of systematic review. Methods: A systematic search was conducted in the following databases: MEDLINE (via PubMed), Lilacs, Scopus and Web of Science. There were no appliedrestrictions in terms of thepublication date. In addition, a manual search was performed on the references of published studies. Observational studies assessing the prevalence of acute clinical manifestations in victims of toxic smoke inhalation in closed environments were included. Results: Of the 4,603 articles identified, eight were included, comprising a total of 233 patients. The signs and symptoms were identified and ranked according to frequency. Dyspnea (58.80%, six studies), carbonaceous sputum (54.51%, four studies), hoarseness (39.91%, three studies), wheezing (34.33%, five studies) and sore throat (33.90%, two studies) were the most frequent acute clinical manifestations of smoke inhalation. Besides these, chest pain and pulmonary edema were observed, respectively in 13.30%, 5.15% of the studies. Conclusion: The results suggest that dyspnea, carbonaceous sputum, hoarseness, wheezing and sore throat were the most frequent acute clinical manifestations in victims of smoke inhalation. Further studies of a higher level of evidence and greater methodological rigor are required.

Resumo Introdução: As lesões pulmonares decorrentes da inalação de fumaça tóxica são as principais causas de morte em vítimas de incêndio; no entanto, informações a respeito das repercussões agudas no sistema respiratório decorrentes da inalação de fumaça e seus constituintes em ambientes fechados ainda são escassas na literatura. Objetivo: Investigar as manifestações clínicas agudas observadas em vítimas de inalação de fumaça tóxica em ambientes fechados através de uma revisão sistemática. Métodos: Uma pesquisa sistemática foi realizada nas seguintes bases de dados: MEDLINE (via PubMed), Lilacs, Scopus e Web of Science. Não houve restrições quanto ao ano de publicação. Além disso, realizou-se uma pesquisa em referências de estudos publicados. Foram incluídos estudos observacionais que avaliaram a prevalência das manifestações clínicas agudas em vítimas de inalação de fumaça tóxica em ambientes fechados. Resultados: Dos 4.603 artigos encontrados, oito foram incluídos, compreendendo um total de 233 pacientes. Os sinais e sintomas foram identificados e classificados de acordo com a frequência com que apareceram nos estudos incluídos. Dispneia (58,80%, seis estudos), escarro carbonáceo (54,51%, quatro estudos), disfonia (39,91%, três estudos), sibilância (34,33%, cinco estudos) e dor de garganta (33,90%, dois estudos) foram as manifestações clínicas agudas mais frequentes de inalação de fumaça. Além disso, dor torácica e edema pulmonar foram observados, respectivamente em 13,30% e 5,15% dos estudos. Conclusão: Os resultados sugerem que dispneia, escarro carbonáceo, disfonia, sibilância e dor de garganta foram as manifestações clínicas agudas mais frequentes nas vítimas de inalação de fumaça tóxica. São necessários novos estudos com alto nível de evidência e melhor rigor metodológico.

Resumen Introducción: Las lesiones pulmonares producidas por la inhalación de humo son las principales causas de muerte entre las víctimas de fuego, sin embargo, informaciones con respeto de las repercusiones agudas en el sistema respiratorio derivadas de la inhalación de humo y sus constituyentes en ambientes cerrados siguen escasas en la literatura. Objetivo: Investigar las manifestaciones clínicas agudas observadas en víctimas de inhalación de humo en ambientes cerrados a través de una revisión sistemática. Métodos: Una pesquisa sistemática fue realizada en las siguientes bases de datos: MEDLINE (vía PubMed), Lilacs, Scopus y Web of Science. No hubo restricciones con relación al año de publicación. Además, se realizó una pesquisa en referencias de estudios publicados. Fueron incluidos estudios observacionales que evaluaron la prevalencia de las manifestaciones clínicas agudas en víctimas de inhalación de humo tóxico en ambientes cerrados. Resultados: De los 4.603 artículos encontrados, ocho fueron incluidos, comprendiendo un total de 233 pacientes. Los signos y síntomas fueron identificados y clasificados de acuerdo con la frecuencia con que aparecieron en los estudios incluidos. Disnea (58,80%, seis estudios), esputo carbonáceo (54,51%, cuatro estudios), disfonía (39,91%, tres estudios), sibilancia (34,33%, cinco estudios) y dolor de garganta (33,90%, de los estudios) han sido las manifestaciones clínicas agudas más frecuentes de la inhalación de humo. Además, dolor torácico y edema pulmonar han sido observados, respectivamente en 13,30% y 5,15% de los estudios. Conclusión: Los resultados sugieren que la disnea, esputo carbonáceo, disfonía y dolor de garganta fueron las manifestaciones clínicas más frecuentes en las víctimas de inhalación de humo tóxico. Son necesarios nuevos estudios con alto nivel de evidencia y mejor rigor metodológico.

Perfil epidemiológico dos pacientes com lesão inalatória que foram atendidos em uma Unidade de Queimados de um Hospital de Pronto-Socorro / Epidemiological profile of patients with inhaled lesions who were treated in a Burns Unit of a First Aid Hospital / Perfil epidemiológico de los pacientes con lesión inhalatoria que fueron atendidos en una Unidad de Quemados de un Hospital de Pronto Socorro

Objetivo: Descrever o perfil e o desfecho pós-alta hospitalar, além de sequelas pulmonares em pacientes com queimaduras inalatórias internados no Hospital de Pronto Socorro de Porto Alegre. Método: Estudo quantitativo, descritivo e transversal desenvolvido no Hospital de Pronto Socorro de Porto Alegre (HPS). Foram selecionados prontuários de pacientes internados na UTI queimados do hospital com diagnóstico de queimadura inalatória durante os anos de 2013 e 2014. Dados sociodemográficos dos pacientes foram coletados, bem como aqueles relacionados ao trauma e à internação, como tipo de queimadura, superfície corporal atingida, tratamento realizado no hospital, necessidade de ventilação mecânica e tempo de internação. Incluíram-se pacientes com lesão inalatória e que também tinham outros tipos de queimaduras, como de pele, mucosas e olhos. Não participaram pacientes que não apresentaram queimadura inalatória. Os pacientes responderam um questionário semiestruturado sobre as principais dificuldades encontradas pós-alta hospitalar e as principais alterações respiratórias remanescentes. Resultados: Os pacientes eram em sua maioria do sexo masculino, adultos, necessitaram de suporte ventilatório, permaneceram internados em tempo prolongado, tiveram queimaduras extensas e de segundo grau, em sua maioria em regiões como face e tórax, além de apresentarem pneumonia como complicação pulmonar. Conclusão: Os resultados sugerem a inserção do profissional fisioterapeuta nos diversos níveis de atenção ao cuidado do paciente queimado.

Objective: To describe the profile and outcome after hospital discharge in addition to pulmonary sequelae in patients with inhaled burns hospitalized at the Hospital of Pronto Socorro in Porto Alegre. Methods: The quantitative, descriptive and cross-sectional study was carried out at the Hospital of Pronto Socorro in Porto Alegre (HPS). The medical records of patients hospitalized in the ICU who were burned at the hospital with a diagnosis of inhalation burn during the years of 2013 and 2014 were selected. Sociodemographic data were collected from the patients, as well as those related to trauma and hospitalization, such as burns, burned body surface, treatment performed at the hospital, need for mechanical ventilation and length of hospital stay. Those with inhaled lesions were included and also presented other types of burns, such as skin, mucous membranes and eyes. Those who did not present inhaled burn were excluded from the study. The patients answered a semi-structured questionnaire about the main difficulties encountered after hospital discharge and the main remaining respiratory changes. Results: Patients were mostly males, adults, required ventilatory support, were hospitalized in a prolonged period, had extensive and second degree burns mostly in regions such as the face and chest, and presented pneumonia as a pulmonary complication. Conclusion: The results suggest the insertion of the professional physiotherapist in the various levels of attention to the care of the burned patient, considering the need for both short and long term rehabilitation in this patient profile.

Objetivo: Describir el perfil y el desenlace post-alta hospitalario además de secuelas pulmonares en pacientes con quemaduras inhaladas internadas en el Hospital de Pronto Socorro de Porto Alegre. Método: El estudio cuantitativo, descriptivo y transversal, fue desarrollado en el Hospital de Pronto Socorro de Porto Alegre (HPS). Se seleccionaron prontuarios de pacientes internados en la UTI quemados del hospital con diagnóstico de quemadura inhalatoria durante los años de 2013 y 2014. Se recogieron datos sociodemográficos de los pacientes, así como aquellos relacionados al trauma y la internación, tratamiento realizado en el hospital, necesidad de ventilación mecánica y tiempo de internación. Se incluyeron aquellos con lesión inhalatoria y que también presentaron otros tipos de quemaduras, como de piel, mucosas y ojos. Se excluyeron del estudio aquellos que no presentaron quemadura inhalatoria.Los pacientes respondieron un cuestionario semiestructurado sobre las principales dificultades encontradas post-alta hospitalaria y las principales alteraciones respiratorias restantes. Resultados: Los pacientes eran en su mayoría del sexo masculino, adultos, necesitaron de soporte ventilatorio, permanecieron internados a tiempo prolongado, presentaron quemaduras extensas y de segundo grado en su mayoría en regiones como cara y tórax, además de presentar neumonía como complicación pulmonar. Conclusión: Los resultados sugieren la inserción del profesional fisioterapeuta en los diversos niveles de atención al cuidado del paciente quemado.

Management of Critical Burn Injuries: Recent Developments / 대한구급학회지

BACKGROUND: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries. METHODS: A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association. RESULTS: The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems. CONCLUSION: Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

Airway management of a series of patients with inhalation injury caused by smoke from smoke pot based on grade classification / 中华护理杂志

In this study,we summarized airway management of a series of patients with inhalation injury caused by smoke from smoke pot based on grade classification,which were:establishment of a special team for these classified patients,classifying the patients into four sub-groups including extremely severe,severe,moderate and mild,establishment of a program for trachea management and relevant measures on these classified sub-groups.Key points of management on extremely severe patients were as follows:protective isolation,mechanical ventilation,nursing of extracorporeal membrane oxygenation and pneumothorax and mediastinal emphysema,prevention of tracheo-esophgeal fistula,nursing cooperation of fiberoptic bronchoscopy.Key points of management on severe patients were as follows:disinfection and isolation,rational oxygen therapy,sputum elimination management,observation of illness status,preparation of emergency treatment,prevention and nursing of complications.Key points of management on moderate patients were as follows:ventilation,oxygen uptake,aerosol inhalation,sputum elimination guidance,respiratory function training.For mild patients,there was no special management except ventilation,aerosol inhalation and regular pulmonary function examination.One patient died due to multiple organ failure complicated with massive hemoptysis,four patients recovered with airway scar proliferation and lung fibrosis,and fifty-five patients fully recovered.

Effects of sivelestat sodium on early inflammatory reaction in rats with smoke inhalation injury / 天津医药

Objective To investigate the effects of sivelestat sodium on early inflammatory reaction in rats with smoke inhalation injury. Methods Forty SPF male SD rats were randomly divided into 5 groups:normal control group (A), injury group (B), smoke inhalation treated with 10 mg/kg sivelestat sodium group (C), smoke inhalation treated with 20 mg/kg sivelestat sodium group (D) and smoke inhalation treated with 30 mg/kg sivelestat sodium group (E), 8 rats for each group. After smoke inhalation injury model was established, the treatment groups were intraperitoneally injected sivelestat sodium 10 mg/kg, 20 mg/kg and 30 mg/kg separately. B group was treated with the same volume of physiological saline. After 24 hours,ELISA was used for detecting serum contents of neutrophil elastase (NE), myeloperoxidase (MPO), tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) in five groups. Meanwhile the water content of lung tissue was measured, and the pathological changes were observed by HE staining. The thickness of alveolar septum was measured and compared between groups. Results Compared with control group, the serum levels of NE, MPO, IL-6, TNF-α, water content of the lung tissue and thickness of alveolar septum were significantly higher in other four groups (P<0.05). Compared with injury group, the serum levels of NE, MPO, IL-6, TNF-α, water content of the lung tissue and thickness of alveolar septum were significantly lower in treatment groups (P<0.05). Compared with 20 mg/kg treatment group and 30 mg/kg treatment group, the serum levels of NE, MPO, IL-6, TNF-α, water content of the lung tissue and thickness of alveolar septum were significantly lower in 10 mg/kg treatment group (P<0.05). Conclusion The result shows that sivelestat sodium can reduce the early inflammatory reaction of rats with smoke inhalation injury and attenuates the lung edema. In this experiment, the treatment effect of 10 mg/kg sivelestat sodium is better than other treatment doses.

Early Predictors of Critical Cases for the Patients Who Visited Emergency Department due to Gas Inhalation: Early Predictors of Severity in Gas Inhalation

PURPOSE: To define early predictors of critical cases involving patients who visited the emergency department (ED) due to gas inhalation, with the goal of identifying patients who require intensive monitoring and treatment. METHODS: The retrospective study was carried out for patients who visited the ED at Ulsan University Hospital due to gas inhalation from March 2014 to February 2016. General demographics, mechanism of accident, critical symptoms, vital signs, blood lab test results, severity, and clinical manifestation were investigated. Patients were divided into a critical group and non-critical group, and predictors of critical cases were investigated by comparing both groups. RESULTS: Of the 180 patients, 26 patients were in the critical group. In this group, more patients displayed altered mentality and cardiac arrest (both p<0.001). The critical group also showed significantly higher fractions for low-blood pressure (systolic blood pressure<90 mmHg; p<0.001), number of critical symptoms (p<0.001), transport by emergency medical services (p=0.003), and consultation involving other departments (p<0.001). Patients in the critical group showed higher Korean Triage and Acuity Scale (KTAS) level (p<0.001), lactate value (p=0.001), and carboxy-hemoglobin value (p=0.017) as well as older age (p=0.001), lower pH (p=0.001), and HCO₃⁻ value (p<0.001). Multiple regression analysis revealed that predictors of critical cases were older age and higher KTAS level (both p<0.001). CONCLUSION: Patients admitted to the ED for treatment of gas inhalation, who were older and had a higher KTAS level, require intensive monitoring and treatment.

Management of Critical Burn Injuries: Recent Developments / 대한중환자의학회지

BACKGROUND: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries. METHODS: A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association. RESULTS: The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems. CONCLUSION: Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

The effects of passive tobacco smoking on the microcirculation of the abdominal wall in rats

ABSTRACT PURPOSE: To analysis the effects of passive smoking on the microstructure of tissues of the abdominal wall regarding microcirculation, using histopathological study of the tobacco exposed rats. METHODS: Twenty four male Wistar rats were divided in Control Group (CG = 8 animals) and Exposition Groups (EG = 16 animals). EG was exposed to cigarette smoke 4x/day for 120 days, while CG was preserved from exposure. Food, water and housing were similar for both groups. After 120 days, urine samples were collected before necropsy to analyze cotinine levels (ng/mL) in urine and blinded histopathological analysis of the abdominal wall performed to count arteries and veins in dermal and muscular fascia layer. RESULTS: No difference in weight was observed between both groups (P>0.05). Cotinine concentration was significantly higher in EG (P<0.05). In dermal layer, the average of vessels per animal was 8.72 (IC95%: 8.31-9.13) for CG and 11,23 (IC95%: 10.09-12.38) for EG. In muscular fascia layer the average of vessels per animal was 17.97 (IC95%: 15.79-20.15) for CG, whereas the average for EG was of 14,85 (IC95%: 12.71-17.01) (P<0.05). CONCLUSION: Exposition to passive smoking may cause increase in the number of vessels in dermal layer, with the opposite effects at the muscular fascia layer.

Queimadura em 60% do corpo em paciente do sexo masculino de 13 anos de idade: relato de caso / Sixty percent of burned body surface area in male patient of 13 years-old: case report / Quemadura en 60% del cuerpo de un paciente masculino 13 años de edad: reporte de un caso

Introdução: As queimaduras estão entre as mais graves lesões suportáveis, não só pela dor, mas pela possibilidade de choques hipovolêmico e séptico proporcionais à extensão e profundidade da área atingida. A sobrevida em pacientes com superfície corporal queimada maior que 30% é pequena e extremamente pequena em 70%. Relato de Caso: L.A.C., 13 anos, admitido com queimadura por etanol decorrente de explosão em ambiente aberto, com 60% da superfície corporal queimada, lesões de 2º grau profundo e 3º grau em face, pescoço, tórax, abdome, dorso, membros superiores, membros inferiores e genitais, com lesão inalatória. Realizou-se reposição volêmica imediata, intubação orotraqueal precoce associada à ventilação mecânica, desbridamentos cirúrgicos, curativos diários, analgesia eficaz, somadas ao suporte nutricional com altas taxas calóricas e proteicas, além do agressivo tratamento da sepse. Alta hospitalar após 3 meses e 7 dias, deambulando, com função renal preservada, sem área queimada exposta e com sequela funcional motora. Conclusão: A conduta precoce é extremamente importante para a sobrevida, visto que esse tipo de lesão tem um alto índice de mortalidade e complexidade. O bom resultado deve-se ao aporte clínico, cirúrgico, sendo que os primeiros cuidados, após o atendimento de emergência, ocorreram no hospital que oferece os serviços de referências para queimados em Mato Grosso do Sul.

Introduction: Burns are among the most serious injuries that the body can withstand, not only for the pain, but also for the possibility of hypovolemic and septic shock proportional to the length and depth of the affected area. Survival in patients with surface body area burned more than 30% is small, and extremely small at 70%. Case Report: L.A.C., 13 years-old, admitted due to burn of ethanol in an open environment explosion, with 60% of total burned surface area, 2nd and 3rd degree lesions in the face, neck, chest, abdomen, back, upper limbs, lower limbs and genitals with inhalation injury. Submitted to immediate volume replacement, early intubation associated with mechanical ventilation, surgical debridement, daily bandages, effective analgesia, added nutritional support with high calorie and protein rates, in addition to aggressive treatment of sepsis. Discharged after 3 months and 7 days, ambulating with preserved renal function, without exposed burned area and with motor functional sequel. Conclusion: Early conduct is extremely important for the survival, as this type of injury has a high mortality rate and complexity. The good results were due to the clinical and surgical support, and because the first care, after emergency care, occurred in the hospital that offers the reference service to burns in Mato Grosso do Sul.

Introducción: Las quemaduras son entre las lesiones más graves que el cuerpo pueda soportar, no sólo para el dolor, sino también para la posibilidad de hipovolémico y choque séptico proporcional a la longitud y la profundidad de la zona afectada. La sobrevida en pacientes con superficie corporal quemada más del 30% es pequeña y muy pequeña en un 70%. Caso Clínico: L.A.C., 13 años, admitió debido a la quema de etanol en una explosión entorno abierto, con 60% de la superficie corporal quemada, lesiones de grado 2 y 3 en la cara, cuello, pecho, abdomen, espalda, extremidades superiores, miembros inferiores y genitales, con lesiones por inhalación. Sometidos a la reposición inmediata, intubación temprana asociada a la ventilación mecánica, el desbridamiento quirúrgico, vendas diarias, una analgesia eficaz, añadido soporte nutricional con altas tasas de calorías y proteínas, además de un tratamiento agresivo de la sepsis. Dados de alta después de 3 meses y 7 días, deambulando con función renal conservada, sin zona quemada expuesta y con secuela funcional del motor. Conclusión: La conducta temprana es extremadamente importante para la sobrevida, ya que este tipo de lesión tiene una alta tasa de mortalidad y la complejidad. Los buenos resultados se debieron al apoyo clínico y quirúrgico, y debido a que el primer cuidado, después de la atención de emergencia, se produjo en el hospital que ofrece el servicio de referencia para las quemaduras en Mato Grosso do Sul.