Mortalidad tras un año de protocolización en el manejo del paciente quemado

Abstract

Background: In 2006, the burn unit of an emergency public hospital in Chile standardized its medical and surgical treatment protocols. Aim: To analyze the evolution of mortality among patients admitted to the unit after the standardization process. Material and Methods: Patients admitted to the unit between March 2005 and March 2006, were analyzed. An early surgical debridement was performed, according to the guidelines, after a standardized reanimation with Lactate Ringer using Parkland formula (4 ml/kg/% burn surface area). All patients were monitored. An algorithm was used to decide the indication of vasoactive drugs or invasive monitorization. Results: Eighty eight patients aged 43 ± 19 years (65% males) were admitted. The estimated percentage body burned was 30 ± 21%, deep in 12.5 ± 17%. A mean of 9.122 ± 6.930 ml of fluid were administered in the first 24 hours. The first surgical debridement was performed at 48 hours (range 1 to 15 days). The first escharotomy was performed at 4.2 days (range 3 hours -15 days), the first covering at 3.8 days (range 3 hours-19 days) the first auto graft at 18 days (range 4-26 days). Operative times in the first three surgical procedures were less than 87 min. Global mortality was 37%. Conclusions: The standardized treatment of burns resulted in an absolute reduction of mortality.