Tecnologías utilizadas en el tratamiento de víctimas de quemaduras en cuidados intensivos: revisión de alcance

Clementino, Kyohana Matos de Freitas; Bezerra, Gabriela Duarte; Gonçalves, Gleice Adriana Araujo; Viana, Maria Corina Amaral; Sampaio, Luis Rafael Leite; Pinheiro, Woneska Rodrigues

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 77 (1) • 2024 • https://doi.org/10.1590/0034-7167-2022-0738 copiar

Tecnologías utilizadas en el tratamiento de víctimas de quemaduras en cuidados intensivos: revisión de alcance

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

analizar las tecnologías utilizadas por el equipo de enfermería en el tratamiento de lesiones cutáneas causadas por quemaduras en pacientes en cuidados intensivos.

Métodos:

se trata de una revisión de alcance realizada en las bases de datos LILACS, Medline, PubMed y CINAHL sin restricciones temporales ni de idioma.

Resultados:

las tecnologías destacadas incluyeron el uso de coberturas especializadas, agentes biológicos como probióticos y cianobacterias, además de terapias de presión negativa y enzimas como la papaína y la colagenasa. Algunas tecnologías, como la plata nanocristalina, mostraron eficacia en el control de infecciones.

Consideraciones Finales:

el estudio identificó las tecnologías esenciales en la atención de quemaduras, enfatizando la necesidad de investigaciones adicionales sobre tecnologías “leves”. Los hallazgos respaldan la promoción de una atención de enfermería basada en evidencia para pacientes quemados en cuidados intensivos y mejoran el conocimiento sobre tratamientos efectivos.

Descriptores:
Quemaduras; Unidades de Cuidados Intensivos; Terapéutica; Tecnología; Atención de Enfermería

ID	Title	Year/Country	Design	Interventions	LE
S1	[Associação de membrana biológica de hemicelulose com pomada de estimulação da epitelização: Relato de caso](⁴4 Lopes DRL, Souza MSC, Barbosa CPL, Silva GWB, Souza AGA. Associação de membrana biológica de hemicelulose com pomada de estimulação da epitelização: relato de caso. Rev Bras Queimaduras[Internet]. 2016 [cited 2021 Jun 25];15(4):283-6. Available from: http://www.rbqueimaduras.com.br/export-pdf/328/v15n4a11.pdf http://www.rbqueimaduras.com.br/export-p... )	2016/Brazil	Case study	Biological membrane of hemicellulose, associated with hydrolyzed collagen gel.	4
S2	Biobrane™ for burns of the pubic region: minimizing dressing changes(¹⁵15 Feng JJ, Le See J, Choke A, Ooi A, Chong SJ. Biobrane™ for burns of the pubic region: minimizing dressing changes. Mil Med Res. 2018;5(1):1-3. https://doi.org/10.1186%2Fs40779-018-0177-2 https://doi.org/10.1186%2Fs40779-018-017... )	2018/Singapore	Case report	Artificial skin.	4
S3	Care in patients with epidermal necrolysis in burn units. A nursing perspective(¹⁶16 Lerma V, Macías M, Toro R, Moscoso A, Alonso Y, Hernández O, et al. Care in patients with epidermal necrolysis in burn units: a nursing perspective. Burns [Internet]. 2018 [cited 2021 Jun 17],44(8):1962-72. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0305417918305205 https://www.sciencedirect.com/science/ar... )	2018/Spain	Descriptive cross-sectional study	Skin cleansing techniques, antiseptics, conservative skin management, and the use of artificial skin.	4
S4	Comparison of analgesic and anxiolytic effects of nitrous oxide in burn wound treatment(¹⁷17 Li L, Pan Q, Xu L, Lin R, Dai J, Chen X, et al. Comparison of analgesic and anxiolytic effects of nitrous oxide in burn wound treatment: a singleblind prospective randomized controlled trial. Medicine. [Internet]. 2019 [cited 2021 Dec 22];98(51). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940169/ https://www.ncbi.nlm.nih.gov/pmc/article... )	2019/China	Randomized controlled clinical trial	Nitrous oxide (N2O) and 50% N2O.	1
S5	Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric thermal burn injuries: study protocol for a randomised controlled trial(¹⁸18 Maleea DH, Bronwyn RG, Steven MM, Robert SW, Kelly F, Demi CB, et al. Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric thermal burn injuries: study protocol for a randomised controlled trial. Trials[Internet]. 2019 [cited 2022 Jun 17];20(1):1-13. Available from: https://trialsjournal.biomedcentral.com/track/pdf/10.1186/s13063-018-3057-x.pdf https://trialsjournal.biomedcentral.com/... )	2019/Australia	Randomized controlled clinical trial	Hydrogel.	1
S6	Enhanced wound-healing performance of a phytopolysaccharide-enriched dressing – a preclinical small and large animal study(¹⁹19 Wang CH, Chang SJ, Tzeng YS, Shih YJ, Adrienne C, Chen SG, et al. Enhanced wound-healing performance of a phyto-polysaccharide-enriched dressing–a preclinical small and large animal study. Int Wound J. 2017;14(6):1359-69. https://doi.org/10.1111/iwj.12813 https://doi.org/10.1111/iwj.12813... )	2017/China	Preclinical study	Calcium Alginate Polysaccharide Dressing (CAPS).	3
S7	Local Probiotic Therapy with Lactobacillus plantarum Mitigates Scar Formation in Rabbits after Burn Injury and Infection(²⁰20 Satish L, Gallo PH, Johnson S, Yates CC, Kathju S. Local probiotic therapy with Lactobacillus plantarum mitigates scar formation in rabbits after burn injury and infection. Surgical infections. [Internet]. 2017 [cited 2021 Jun 17];18(2):119-27. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374869/pdf/sur.2016.090.pdf https://www.ncbi.nlm.nih.gov/pmc/article... )	2017/United States of America	Experimental study	Lactobacillus plantarum.	2
S8	Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children(²¹21 Frear CC, Cuttle L, McPhail SM, Chatfield MD, Kimble RM, Griffin BR. Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children. Br J Surg. 2020;107(13):1741-50. https://doi.org/10.1002/bjs.11993 https://doi.org/10.1002/bjs.11993... )	2020/Australia	Randomized clinical trial	Silver dressing with silicone cover.	1
S9	Synechococcus elongatus PCC7942 secretes extracelular vesicles to accelerate cutaneous wound healing by promoting angiogenesis(²²22 Yin H, Chen CY, Liu YW, Tan YJ, Deng ZL, Yang F, et al. Synechococcus elongatus PCC7942 secretes extracellular vesicles to accelerate cutaneous wound healing by promoting angiogenesis. Theranostics[Internet]. 2019 [cited 2021 Jun 17];9(9):2678. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525994/pdf/thnov09p2678.pdf https://www.ncbi.nlm.nih.gov/pmc/article... )	2019/China	Randomized controlled clinical trial	S. elongatus PCC 7942.	1
S10	New lupeol esters as active substances in the treatment of skin damage(²³23 Malinowska M, Miroslaw B, Sikora E, Ogonowski J, Wojtkiewicz AM, SzaleniecM, et al. New lupeol esters as active substances in the treatment of skin damage. PloS One. 2019[cited 2021 Dec 29];14(3):e0214216. https://doi.org/10.1371/journal.pone.0214216 https://doi.org/10.1371/journal.pone.021... )	2019/United States of America	Randomized controlled clinical trial	Lupeol derivatives.	1
S11	Chitosan-Gentamicin Conjugate Hydrogel Promoting Skin Scald Repair(²⁴24 Yan T, Kong S, Ouyang Q, Li C, Hou T, Chen Y, et al. Chitosan-gentamicin conjugate hydrogel promoting skin scald repair. Marine Drugs. 2020;18(5):233. https://doi.org/10.3390/md18050233 https://doi.org/10.3390/md18050233... )	2020/China	Randomized controlled clinical trial	Chitosan-gentamicin conjugate (CS-GT).	1
S12	[Fator de crescimento transformador beta 3 e a melhora macro e microscópica de cicatrizes: Uma revisão bibliográfica] (²⁵25 Paniago GR, Cabral IBP, Cruvinel F, Cruvinel Filho HC. Fator de crescimento transformador beta 3 e a melhora macro e microscópica de cicatrizes: Uma revisão bibliográfica. Rev Bras Queimaduras [Internet]. 2019[cited 2022 Dec 13];18(3):180-5. Available from: http://www.rbqueimaduras.com.br/export-pdf/482/v18n3a08.pdf http://www.rbqueimaduras.com.br/export-p... )	2019/Brazil	Literature review	Avotermin.	5
S13	[Guia de prática clínica para o cuidado de enfermagem ao paciente queimado: Metodologia ADAPTE](²⁶26 Fontana TS, Souza EN, Viegas K. Guia de prática clínica para o cuidado de enfermagem ao paciente queimado: metodologia ADAPTE[Internet]. Porto Alegre: UFCSPA; 2021[cited 2022 Out 02];102 p. Available from: https://ufcspa.edu.br/documentos/ppg/enfermagem/Guia-de-prtica-clnica-para-o-cuidado-de-enfermagem-ao-paciente-queimado.pdf https://ufcspa.edu.br/documentos/ppg/enf... )	2021/Brazil	ADAPTE Methodology	3-layer nanocrystalline silver dressing; Hydrofiber with silver.	7
S14	[Manual de queimaduras para estudantes](¹1 Lopes DC, Ferreira ILG, Adorno J. Manual de queimaduras para estudantes[Internet]. Brasília: Sociedade Brasileira de Queimaduras; 2021[cited 2021 Jun 18];178 p. Available from: https://sbqueimaduras.org.br/material/3091 https://sbqueimaduras.org.br/material/30... )	2021/Brazil	Expert opinion – Manual	Pressotherapy; Collagenase; 1% silver sulfadiazine.	7

Category/Classification	Intervention Used	Justification
Antimicrobial and Healing / Hard Technology	Lactobacillus plantarum	Reduces the intensity and duration of Pseudomonal infection. Attenuates collagen deposition.
	Chitosan-gentamicin conjugate (CS-GT)	Promotes collagen fibrosis. Reduces cytokine levels in an inflammatory response. Accelerates wound healing.
	Silver hydrofiber	Facilitates healing and reduces the risk of wound bed infections. Provides bactericidal action against planktonic microorganisms.
	Collagenase	Promotes liquefaction of necrotic tissue without deteriorating granulation tissue. Restricts the formation of hypertrophic scars in superficial 2nd-degree burns. Reduces the basal substrate for bacterial proliferation.
Analgesic and Healing / Hard Technology	Artificial skin	Minimizes infection and promotes wound healing. Provides pain relief in epidermal necrolysis.
	Calcium alginate (CAPS)	Reduces wound size. Maintains moist wounds. Promotes granulation tissue growth, pain reduction, and scar formation. Absorbs wound fluids.
	Hemicellulose biological membrane	Pain relief. Accelerates the epithelialization process.
Analgésico/Tecnologia Dura	Hydrogel	Pain relief.
Analgésico/Tecnologia Dura	Nitrous oxide (N2O) and 50% N2O	Reduces pain and anxiety.
Analgesic / Hard Technology	Nanocrystalline silver 3-layer	Minimizes wound trauma during dressing changes due to the low-adherence contact layer. Provides an effective antimicrobial barrier to the wound bed.
Analgesic / Hard Technology	Silver sulfadiazine 1%	Controls local infections by inhibiting bacterial growth. Indicated only in the early days of burn treatment, for necrotic tissue or infection.
Antimicrobial / Hard Technology	S. elongatus PCC7942 cyanobacterium	Accelerates cutaneous wound healing. Promotes angiogenesis and burn repair in mice.
	Silver hydroalginato	Favors angiogenesis. Accelerates tissue matrix maturation.
	Negative Pressure Wound Therapy (NPWT)	Favors spontaneous total reepithelialization. Reduces the risk of ischemic damage.
	Nile tilapia skin	Promotes tissue regeneration and healing capacity. Induces cell migration/division. Increases collagen synthesis by fibroblasts.
	Lupeol	Stimulates human skin cell proliferation.
	Avotermin	Influences fibroblast and myofibroblast migration to the wound site. Reduces excessive collagen in scar formation. Allows for greater migration of epithelial cells. Restores epithelial-mesenchymal interactions. Accelerates healing.
	Pressotherapy	Prevents the formation of hypertrophic or keloid scars. Reduces fibroblast proliferation and collagen synthesis.

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[1] Corresponding author: Kyohana Matos de Freitas Clementino E-mail: kmfreitasclementino@gmail.com