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Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children
Shingo Takahara1, Sadahiro Sai2, Tomoaki Kagatani2
1Department of Cardiovascular Surgery, Miyagi Children's Hospital, Sendai, Japan dr_takashin@hotmail.com takahara@med.tohoku.ac.jp.
Insights
Vacuum-assisted closure (VAC) therapy is safe and effective for pediatric post-sternotomy mediastinitis. This treatment did not significantly impact hemodynamics in children, even those with complex heart conditions.
Area of Science:
- Pediatric cardiac surgery
- Thoracic surgery
- Critical care medicine
Background:
- Post-sternotomy mediastinitis presents significant morbidity with debated management strategies.
- Vacuum-assisted closure (VAC) is effective in adults but its use in pediatric patients is limited due to hemodynamic concerns.
Purpose of the Study:
- To evaluate the outcomes of VAC therapy in pediatric patients with post-sternotomy mediastinitis.
- To assess the impact of VAC on the hemodynamic parameters of these young patients.
Main Methods:
- Retrospective analysis of six pediatric patients treated with VAC for post-sternotomy mediastinitis.
- Hemodynamic parameters including mean blood pressure, heart rate, urinary output, and vasoactive-inotropic score were monitored before and after VAC initiation.
Main Results:
- VAC therapy was used for a median of 12 days in pediatric patients (median age 6.4 months).
- No significant changes in mean blood pressure or urinary output were observed.
- A significant decrease in mean heart rate was noted post-VAC initiation, with minimal need for vasoactive agents.
Conclusions:
- VAC therapy is safe and effective for treating post-sternotomy mediastinitis in pediatric patients.
- The therapy does not appear to adversely affect hemodynamics in children, including those with complex congenital heart anomalies.
Objectives:
Post-sternotomy mediastinitis is a significant morbidity with controversial management. Vacuum-assisted closure (VAC) has been used to treat mediastinitis, with many reports documenting its efficacy and feasibility, particularly in adults. However, its use is not prevalent in the paediatric population because of concerns that it may deteriorate haemodynamics. This study aimed to evaluate outcomes and effects of VAC on the haemodynamics of paediatric patients with post-sternotomy mediastinitis.
Methods:
Six patients were treated with VAC between April 2005 and March 2013. We retrospectively investigated their profiles, clinical outcomes and haemodynamic changes, including mean blood pressure (MBP), mean heart rate (MHR), urinary output, amount of diuretics and vasoactive-inotropic score (VIS), before and after VAC initiation.
Results:
The median age and body weight of patients were 6.4 months and 4.5 kg, respectively. Three patients (50%) had single ventricular physiology. The median VAC duration was 12 days. One patient died of pulmonary venous obstruction after mediastinitis was cured. The average MBPs in every 8-h period were examined, and there were no significant changes (P = 0.773); the average MHRs were examined in the same manner and they decreased significantly after initiation of VAC (P = 0.032). Only 2 patients required vasoactive agents. The VIS did not change in 1 patient and decreased in the other. The mean amount of diuretics administered and urinary output per body weight did not change significantly (P = 0.395 and 0.273, respectively).
Conclusions:
In conclusion, the haemodynamics of children were not significantly affected by the negative pressure of VAC, indicating that this therapy may be safe and effective for post-sternotomy mediastinitis, even in small children with complex cardiac anomalies.
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