Burn injuries represent a major cause of mortality and morbidity as well as a significant drain on limited resources, particularly in the developing world. Advances in resuscitation, critical care, protective ventilatory strategies, earlier complete debridement complemented by more aggressive treatment of burn wound sepsis have reduced the mortality of thermal injuries. There has also been a move to focus on education and prevention campaigns, which have borne fruit and resulted in some reduction in the incidence of burns in the paediatric population. Burn care, once a Cinderella specialty, has become a well focused multi-disciplinary specialty in its own right. Burn injury is dissimilar to many forms of trauma. In major burns, the initial trauma may be limited to the skin alone or skin and lungs, but all organ systems are rapidly involved as the physiological derangement becomes systemic. The burden of this multi-system insult is substantial. Globally, the World Health Organisation estimated that fire-associated burns alone directly resulted in over 320,000 deaths in 2002, and in the USA, approximately 1million children sustain burns each year. Australasian guidelines suggest that all adult burns with greater than 15% total body surface area (TBSA) and >10% TBSA burn in children will require fluid resuscitation and possibly critical care support at some point in their hospitalisation. Mortality in these patients with severe burns follows a bimodal pattern of early and late deaths. Causes of early death comprise refractory shock, inability to obtain a safe airway or provide adequate oxygenation, co-existent trauma, non-survivable carboxyhaemoglobin poisoning, and decisions that injuries are non-compatible with recovery, leading to therapy withdrawal. With improved resuscitation strategies, 95% of patients survive the early resuscitation phase. Late deaths are secondary to sepsis normally associated with wound infection and multiple organ failure. The morbidity associated with burn injury continues well after the acute hospital admission, frequently for up to several years post burn injury, as is witnessed by prolonged rise in basal metabolic rate and worsening scar tissue1, 2. It has been calculated that in children approximately 60% of the cost of burn care occurs post wound closure; that is, dealing with the disabling and disfiguring contractures associated with hypertrophic scar3, 4. Hence, research and new modalities are being aimed at reducing cost of treatment and improving quality of life for survivors of burn injury. Thus, this PhD aims to reflect the multidisciplinary nature of modern day burn care, with the inclusion of seven published papers and one book chapter covering prevention and education relevant to paediatric burns, treatment and minimisation of wound infection , and scar minimisation, along with the first study into the relevance of fetal wound healing post burn injury.

The inhalation lesion is one of the biggest mortality causes in fire exposed patients at closed places. Medium and long follow-up respiratory consequences are still rarely reported at world literature. Alveolar-capillary membrane commitment caused by inhaled particles can persist during several years and progress to bronchiolitis obliterans. Thereby, the objective of this work was to evaluate the Diffusing Capacity for Carbon Monoxide (DLCO) lung test, at patients that inhaled toxic smoke at a fire in the nightclub Kiss at January 2013, in Santa Maria, parallel 29°, south Brazil, after first year follow-up. Were included 64 patients that were submited to DLCO and 6-minutes Walk Test (WT6) measurements. Dates were obtained by standard formularies including demographic characteristics, respiratory symptoms and inhalatory medication use. DLCO average was 63% (20,95 mL/mmHg/min) from predict and WT6 distance was 505,55 meters. At studied sample, 21,8% were asthmatics and when compared to no-asthmatics, they had better DLCO (p = 0,017). There was no statistical significance when compared other variables how: tracheal intubation, dyspnea, tabagism, dessaturation at WT6, smoke exposure time and intubation duration to DLCO results. Studied patients had a DLCO reduction greater than current literature. Development of chronic pulmonary complications, especially bronchiolitis obliterans, is a concrete possibility and must be better clarified and adequate screened. Late development of this kind of complication makes a prolonged ambulatorial follow-up indispensable. / A lesão inalatória é uma das grandes causas de mortalidade em pacientes expostos a incêndios fechados. As consequências respiratórias a médio e longo prazo nos sobreviventes ainda é pouco relatada na literatura mundial. O comprometimento da membrana alvéolo capilar pelas partículas inaladas pode persistir ao longo dos anos e progredir para bronquiolite obliterante. Desta forma, o objetivo deste trabalho foi avaliar o teste de difusão do monóxido de carbono (DLCO), nos pacientes que inalaram fumaça tóxica no incêndio ocorrido na Boate Kiss em Janeiro de 2013, em Santa Maria, paralelo 29°, no Sul do Brasil, após o primeiro ano do incêndio. Ao todo foram incluídos 64 pacientes, os quais foram submetidos à medida da DLCO e ao teste de caminhada de seis minutos (TC6). Os dados foram obtidos através de questionário contendo informações que incluíam características dos pacientes, sintomas respiratórios e uso de medicação inalatória. A DLCO média foi 63% do previsto (20,95 mL/mmHg/min) e a média da distancia no TC6 foi 505,5 metros. Na amostra estudada, 21,8% eram asmáticos e quando comparados a não asmáticos, possuíam melhor DLCO com p 0,017. Não houve significância estatística quando comparados outras variáveis como: intubação orotraqueal, dispneia, tabagismo, dessaturação no TC6, tempo de exposição, dias de intubação ao resultado da DLCO. Os pacientes estudados apresentaram redução na DLCO maior que a encontrada na literatura. O desenvolvimento de complicações pulmonares crônicas, em especial, bronquiolite obliterante, é uma possibilidade concreta e deve ser esclarecida e adequadamente rastreada. A característica tardia dessas complicações torna o seguimento ambulatorial prolongado imprescindível.