[Descending Necrotising Mediastinitis: the Choice of Drainage]
Jarmil Safranek1, Martin Skala2, Sarka Vejvodova2
1Chirurgische Klinik, Universitätskrankenhaus Pilsen, Tschechische Republik.
Introduction:
Descending necrotising mediastinitis (DNM) is a rare, but very severe, septic condition, caused by the spread of infection from the neck to the mediastinum. Delay in diagnosis and inadequate surgical procedures may lead to a life-threatening situation.
Material:
We retrospectively evaluated a group of patients who suffered from DNM and were treated in our department by mediastinal drainage in the last 10 years (2010 - 2019). All patients required one of the following methods of drainage: cervicomediastinal, mediastinothoracic or cervicomediastinothoracic "Rendevouz" drainage (MTC-D). In the group, we evaluated the source of infection, microbiologic findings, method of mediastinal drainage, length of hospitalisation, ventilation duration and inflammatory laboratory parameters.
Results:
In total, we treated 22 patients with DNM, including 14 men and 8 women, aged 23 - 85 years, with a mean age of 54.1 years. After the spread of infection, in 8 cases the initial cervicomediastinal type of drainage had to be followed by one of the types of thoracic drainage. As the final method, in 8 patients we chose irrigation drainage from the cervical approach, from thoracotomy in 6 cases and in 8 cases irrigation CMT-D. The method of mediastinal drainage was chosen according to the initial CT findings, and further intervention was chosen according to CT signs during the treatment. Four patients died of DNM (mortality 18.2%). Pharyngeal focus was responsible for 15 cases of DNM; odontogenic infection caused 6 DNM cases; in 1 case the origin was unclear. Although we always chose the method individually and CMT-D for the most difficult cases, there were no statistically significant (p < 0.05) differences between the evaluated parameters. For CMT-D, there was even a shorter hospital stay (not significant) and ventilation duration.
Conclusion:
In cases of DNM with severe inflammation of caudal and distal compartments of the mediastinum we consider CMT-D as an ideal method of treatment. This appraoch is radical enough and in our group of patients, despite the severity of this illness, both the length of treatment and mortality were sufficient.
Insights
Descending necrotising mediastinitis (DNM) is a severe infection. Cervicomediastinothoracic drainage (CMT-D) is an effective treatment, showing promising results in reducing hospital stay and mortality for DNM patients.
Area of Science:
- Thoracic Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Descending necrotising mediastinitis (DNM) is a rare but life-threatening infection.
- Prompt diagnosis and effective surgical intervention are crucial for patient survival.
Purpose of the Study:
- To evaluate the efficacy of different mediastinal drainage methods for DNM.
- To assess the outcomes of cervicomediastinothoracic drainage (CMT-D) in severe DNM cases.
Main Methods:
- Retrospective analysis of 22 DNM patients treated between 2010-2019.
- Comparison of cervicomediastinal, mediastinothoracic, and CMT-D techniques.
- Evaluation of infection source, microbiology, drainage method, hospital stay, ventilation duration, and inflammatory markers.
Main Results:
- Pharyngeal and odontogenic infections were the primary sources of DNM.
- CMT-D was utilized for complex cases, with no statistically significant differences in outcomes compared to other methods.
- A trend towards shorter hospital stays and ventilation durations was observed with CMT-D.
Conclusions:
- CMT-D is considered an ideal and radical treatment for DNM involving extensive mediastinal inflammation.
- The study demonstrates sufficient treatment length and acceptable mortality rates for DNM patients managed with CMT-D.
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