1. The International NNuurrsseess SScciieennttiiffiicc CCoonnffeerreennccee
EEFFFFEECCTT OOFF HHYYDDRROOTTHHEERRAAPPYY
OONN SSEEVVEERREE BBUURRNN PPAATTIIEENNTTSS
Cao Thuy Dung RN.
Vietnam National Institute of Burns
5. BBAATTHHIINNGG PPRROOCCEEDDUURREE
Patients Preparation
- Clinical Exam, explain procedure
- protect the food of catheters
- Choose temparature of water
resource
Bathing, cleaning with chloherxidine
Caring after bathing
- Drying and Warm up
- Cover with local treatment drugs
- Preventing hypothermia, size effect of
anaesthesia
ANAESTHESIA
- Pain killer: Dolargan 0,1g,
Morphin 10 mg
- Intravenous Ketamin
Supplement ing
anaesthetic medication
in bath process
9. PPAATTIIEENNTT’’SS CCHHAARRAACCTTEERRIISSTTIICCSS
Characteristics X ± SD Min – Max
Age (year) 23,51 11 –– 6622
Burns area (%) 49,23 ± 19.73 1111 –– 9900
Deep burns area (%) 26,28 ±12.82 00 –– 7700
Admitted time after burns (h) 8,34 ± 2.16 11 –– 4477
Male/ female rate 4,6
Inhalation injury n (%) 13 (33.3)
Average age: 23,51 year old
All patients were severe burn ( ABA criteria, 1984)
10. Bathing frequencies
Number of bathing n %
22 0077 1177,,9955
3 19 48,72
44 1122 3300,,7777
55 11 22,,5566
Total 3399 110000
Patients who was bathed 3 times have the hinghest
percentage (48,72%)
11. AANNAAEESSTTHHEESSIIAA MMEETTHHOODDSS
Patients Ketamin Pain-killer Total
AAdduullttss 11 ((66,,6677%%)) 2244 ((9933,,3333%%)) 2255 ((110000%%))
CChhiillddrreenn 1133 ((9922,,8866%%)) 11 ((77,,1144%%)) 1144 ((110000%%))
• Intravenous anaesthesia was mainly used in children (92,86%),
while pain-killer was mostly used in adults (93,33%).
12. BATH AND WATER TEMPARATURE
Bath-time(min) X±SD Min-Max
Children 21 ± 5.3 15 - 28
Adults 28,46 ± 5,36 18 - 38
Temparature of
water (°C)
Children 35,48 ± 2,3 34 - 36
Adults 34,45 ± 4,37 30 - 38
• Bath-time: 28 mins in adults, 21 mins in children
• Proper water temp: 34,45°C in adult, 35,48°C in children
Petrofsky J et al (2010) : Time of hydrotherapy should not over 20
mins due to the high risk: drop in patients’ temp
14. CULTURING THE BATH WATER
n (%) Positive negative
40 (100%) 0 (0%) 40 (100%)
t With 40 times of cultures, thheerree wwaass nnoo ppoossiittiivvee ssaammppllee
15. ISOLATED BURN WOUND CULTURE
Bacteria
TIME POINT
Before bathing (n = 90) After bathing (n = 90)
n % n %
Positive sample (*) 61 67,77 15 16,67
S. aureus 5 5,56 0 0
P. aeruginosa 20 22,22 7 7,78
K. pneumonia 12 13,33 5 5,56
P. aeruginosa –
4 4,44 0 0
K.pneumonia
Ent.faecium 7 7,78 3 3,33
Aci.Baumanii 5 5,56 0 0
S. aureus - P.aeruginosa 4 4,44 0 0
S. aureus – Ent.faecium 4 4,44 0 0
There are many bacterial species before hydrotherapy, number of groun samples
after hydrotherapy decreased considerably.
Palmieri TL và Greehalgh DG (2002): Hydrotherapy helps to control the burns
wounds, clean up baterium
16. BURN WOUND BACTERIAL QUANTITY
Bacteria Time point p
Before bathing After bathing
S.aureus 537,34 ± 29,2 112,34 ± 15,3
< 0,05
P.aeruginosa 582,36 ± 11,51 94,2 ± 9,28
K.pneumonia 383,53 ± 16,36 57,15 ± 6,26
Ent.faecium 560,36 ± 21,80 83,26 ± 9,13
Aci.Baumanii 312,7± 11,24 0
Bacterial quantity after bathing decrease ; p <0,05
18. BACTERIAL QUANTITIES AFTER
HYDROTHERAPY D1 – D3 (x 103)
• The number of bacteria after hydrotherapy increased gradually and reached
at equivalent threshold prior hydrotherapy 3 day later
Other authors: hydrotherapy should be taken every 2-3 days to reduce re-infectious
risk.
19. WOUND HEALING OF PARTIAL BURNS
Burn degree Patient
Number of hydrotherapy
Once Twice ≥ 3 times
Superficial
dermal burn
Children 7,3 ± 1,8 6,1 ± 0,9
Adults 10,3 ± 1,2 9,2 ± 1,6 8,3 ± 1,7
Dermal burn
Children 11,7 ± 1,1 10,0 ± 1,5 9,1 ± 1,7
Adults 13,5 ± 1,8 12.8 ± 1,2 11.5 ± 1,1
Shorter time for wound healing for patients with more frequency of bathing
20. SKIN AUTO-GRAFT STICKING RESULT
Taken graft
skin
Prior surgery
bathing Without bathing
Amount % Number %
GGoooodd 3322 9944,,1111 22 4400
FFaaiirr 22 55,,8899 33 6600
TToottaall 3344 110000 55 110000
Bathing before surgery: making good condition for skin graft
Palmieri TL (2002): cleaned wound®decrease infectionous fators ®
making good wound bed
23. SSUUGGGGEESSTTIIOONN
1. Continue studying to evaluate the effect of hydrotherapy in
severe patients with the higher number of patients
2. Setting up and completing the process of hydrotherapy
for severe burns patients required mechanical
ventilation, the elder…
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