Related Experiment Videos
Postoperative mediastinitis in children: improvement of simple primary closed drainage
Christine Anslot1, Sylvie Hulin, Yves Durandy
1Intensive Care Unit of Pediatric Cardiac Surgery, Institut Jacques Cartier, Massy, France.
Insights
Simple primary closed drainage effectively sterilizes the mediastinum in pediatric patients. This technique improves outcomes and allows for shorter antibiotic courses, reducing patient burden.
Area of Science:
- Cardiovascular Surgery
- Pediatric Surgery
- Infectious Diseases
Background:
- Mediastinitis is a serious complication following surgery, leading to significant patient morbidity.
- A simple primary closed drainage technique was introduced in 1989 to treat mediastinitis.
- This study details improvements and outcomes of this technique.
Purpose of the Study:
- To describe modifications and evaluate the efficacy of simple primary closed drainage for treating mediastinitis.
- To assess the impact of the technique on mediastinal sterilization and patient recovery.
Main Methods:
- Utilized Redon catheters with strong negative-pressure drainage for infected areas post-debridement.
- Daily cultures of mediastinal effluents guided catheter removal upon sterilization.
- Patients were categorized into isolated mediastinitis, mediastinitis with endocarditis, and mediastinitis with other organ failure groups.
Main Results:
- Sixty-four pediatric patients (neonates, infants, children) were treated over 10 years.
- Group 1 (isolated mediastinitis) showed rapid sterilization (4 days), short antibiotic courses (11 days), and no mortality.
- Groups 2 and 3 had longer sterilization times and hospital stays, with some mortality not directly attributed to mediastinitis.
Conclusions:
- The improved simple primary closed drainage technique is effective and reliable for mediastinal sterilization.
- Shorter antibiotic courses are feasible, improving patient tolerance, especially in pediatric cases.
Background:
Mediastinitis is a significant cause of postoperative morbidity. In 1989, we proposed simple primary closed drainage as a new treatment. Our goal is to describe improvements made to the original technique.
Methods:
After wound debridement, infected areas were drained with Redon catheters connected to strong negative-pressure drainage bottles. Mediastinal effluents were cultured every day, and the catheters were withdrawn when the effluent culture was negative for microorganisms. Patients were classified into three groups: isolated mediastinitis (group 1), mediastinitis associated with endocarditis (group 2), and mediastinitis associated with other organ failure (group 3).
Results:
Sixty-four patients were treated during a 10-year period: 15 neonates, 33 infants, and 16 children. Group 1 consisted of 40 patients. The time to mediastinal sterilization was 4 days (range, 1 to 14 days), and the antibiotic course was 11 days (range, 7 to 28 days), with a hospital stay of 13 days (range, 10 to 30 days). No deaths occurred in this group. Group 2 consisted of 7 patients. The time to mediastinal sterilization was 8 days (range, 3 to 10 days), and the antibiotic course was 30 days (range, 26 to 37 days), with a hospital stay of 37 days (range, 20 to 54 days). One patient in group 2 did not survive. Group 3 consisted of 17 patients. The time to mediastinal sterilization was 6 days (range, 1 to 10 days), and the antibiotic course was 15 days (range, 10 to 31 days), with a hospital stay of 20 days (range, 18 to 36 days). Two patients in group 3 did not survive. None of the deaths was directly related to mediastinitis, as the mediastinum was sterile in all 3 patients before death.
Conclusions:
This simple treatment was efficient and reliable in achieving mediastinal sterilization. In addition, short antibiotic courses decreased restraint, which is poorly tolerated in pediatric patients.
Related Concept Videos
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:17Pulmonary Cycle: Exhalation
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
01:22Aneurysm IV: Nursing Management