Protocolo de tratamento cirúrgico de pacientes queimados

Abstract

Introduction: Burns constitute a complex clinical condition associated with high morbidity, increased risk of infection, metabolic instability, and significant functional impairment. Surgical management of burn patients involves decisions related to timing of intervention, debridement techniques, skin grafting, use of flaps, wound dressing management, and adjuvant therapies. The absence of standardized protocols contributes to variability in clinical practice and an increased risk of complications. Objective: To develop a Standard Operating Procedure (SOP) aimed at standardizing surgical management strategies for the treatment of burn patients. Methodology: This study describes the development of a SOP focused on the surgical management of burn patients. The protocol was structured based on adaptations of the Brazilian Ministry of Health guidelines for the development of clinical care protocols, incorporating systematic steps including problem definition, review of scientific evidence, organization of surgical conduct, and standardization of care practices related to burn surgery. Results: Early excision and grafting were associated with reduced rates of infection, sepsis, and length of hospital stay in patients with deep burns. In extensive burns, staged debridement and grafting were identified as a safe strategy to minimize blood loss, hypothermia, and hemodynamic instability, with each procedure recommended to be limited to approximately 20% of the total body surface area burned. Systematic assessment of graft integration (graft take), combined with monitoring of flaps, vital signs, pain, and surgical drains, enabled early detection of surgical failures and complications, facilitating timely interventions. Adjuvant therapies, such as laser therapy and hyperbaric oxygen therapy, demonstrated benefits in selected cases, particularly in optimizing wound healing and preserving the viability of grafts and flaps. Discussion: The findings indicate that the implementation of structured surgical protocols in burn care enables systematic integration of clinical assessment, operative planning, and postoperative follow-up. This approach contributes to the standardization of care practices, reduces variability in clinical decision-making, and supports improved functional and clinical outcomes. The establishment of operational criteria for excision extent and operative time enhances perioperative safety, especially in patients with extensive burns and increased metabolic risk. Conclusion: The proposed protocol enhances the quality of surgical care for burn patients by establishing objective guidelines for the planning, execution, and monitoring of surgical interventions. Its application promotes greater patient safety, optimizes clinical outcomes, and contributes to improvements in the overall quality of care, supporting its applicability in institutional and specialized burn care settings.