Optimal Heating Temperature in Major Burns Patients

pre and post intervention quasi-experimental epidemiological study without a control group will be carried out in large burned patients that will evaluate the influence on metabolic expenditure of the inclusion of active external rewarming in the control of body temperature.

the heavily burned patient requires specific care to prevent hypothermia and maintain body temperature. You are at high risk of developing hypothermia in the acute phase due to heat losses from convection, radiation, evaporation, and conduction. After the acute phase, the patient due to physiological mechanisms and the hypermetabolic response mainly demands a temperature close to 38.5ºC, ruling out the infectious focus. According to the authors, environmental temperatures between 28-33ºC are recommended for the care of these patients to decrease energy expenditure. The research carried out has studied the influence of passive external heating (environmental regulation), without including the influence of active external heating (heat blankets, heating plate ...) or the study of the thermal comfort of large burned patients and of professionals who provide them they attend. A pre and post intervention quasi-experimental epidemiological study without a control group will be carried out in large burned patients that will evaluate the influence on metabolic expenditure of the inclusion of active external rewarming in the control of body temperature. Metabolic expenditure will be measured by indirect calorimetry in the usual treatment with passive external rewarming and post-intervention in the combination of passive and active external heating. The combination of passive and active external reheating will previously study the operating temperature in various cases for optimal application, as well as the definition of thermal comfort in the large burn unit. The specific training of the personnel involved in the care of these patients will be required for the application of the evidence-based recommendations and the evaluation of their implementation.

A pre and post intervention quasi-experimental epidemiological study without control group, will be carried out in large burned patients that will assess the influence on the metabolic expenditure of the inclusion of active external reheating in the control of the environmental temperature.

Passive external overheating in the environmental temperature control adjusted to thermal comfort. Measure during 6 hours with indirect calorimetry

Combination of passive and active external heating with heating plate Measure during 6 hours with indirect calorimetry

Combination of passive and active external heating with convective air blanket Measure during 6 hours with indirect calorimetry

It is a heating device that is adjustable in height up to 50 cm from the patient and generates radiant heat at low temperature (up to 39 ◦C) distributed evenly. It is equipped with an adjustable 0-9 potentiometer and has a skin temperature probe as a control and safety mechanism Measure during 6 hours with indirect calorimetry in first week

Composed of a unit that produces hot air and forced air adjustable from 38ºC to 43ºC. Sends hot forced air distributed by tubular blanket that convectively heats the patient by diffusing hot air directed at the patient through the textile pore of the air blanket Measure during 6 hours with indirect calorimetry in first week

Compare the metabolic expenditure of burned patients according to the heating method between the combination of active and passive external adjusted to thermal comfort versus external passive overheating.

Define the optimal environmental temperature according to the characteristics of the patient with a large burn during the acute phase, assigning the available resources.

Evaluate the nursing care plan in the thermoregulation of the burned patient according to the standardized nurse taxonomy.

Inclusion Criteria: Patients over 18 years of age. Patients with thermal burns. Patient with high burn criteria according to ABA: 2nd degree burn Patient 18 - 59 years: SCQ> 20% Patient> 60 years or pathology: SCQ> 10% 3rd degree burn SCQ> 10% Patients on mechanical ventilation Exclusion Criteria: Sepsis criteria according to ABA. Enzyme debridement application (data within 24 hours). 6 hours after a surgical intervention. After 2 hours after healing burns Patients in hemorrhagic shock