Comparison between closed drainage techniques for the treatment of postoperative mediastinitis

Berg, Hans F.; Brands, Willem G.B; Geldorp, T R van; Kluytmans-Vandenbergh, Marjolein F. Q.; Kluytmans, Jan

doi:10.1016/s0003-4975(00)01524-1

Cited by 70 publications

(55 citation statements)

References 19 publications

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“…This study has demonstrated a mediastinitis incidence rate of 2.4% (n=25) in the post-operative period following cardiovascular surgery matching the spectrum reported in the literature, which ranges from 0.2% to 5% [6].…”

Section: Discussionsupporting

confidence: 83%

Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas

Sá¹,

Silva

Lima³

et al. 2010

Rev Bras Cir Cardiovasc

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Results: On average, complication occurred within 13 days after operation; in a total of 25 lethal cases (2.4%), deaths occurred in eight (32%). Several risk factors for mediastinitis were identified as follows: 56% diabetes, 56% smoking, 20% obesity, 16% chronic obstructive pulmonary disease, and 8% end-stage renal disease. Mediastinitis was reported in 21 (84%) patients submitted to coronary artery bypass grafting and it was related to a major risk for development of infection (IC 3.44-8.30, P=0.0001). High rates of complications were observed: respiratory failure (44%), stroke (16%), cardiogenic shock (12%), acute renal failure (28%), pulmonary infection (36%), multiple organs failure (16%), and sternal dehiscence (48%). Bacterial cultures of exudates were positive in 84% of patients; Staphylococcus aureus was the most frequently pathogen (28.8%) detected.Conclusion: Mediastinitis remains as a severe surgical complication and difficult to manage in postoperative cardiovascular surgery. The disease has low incidence rate but high lethality. Coronary bypass was associated to a major risk for development of infection.Descriptors: Infection. Mediastinitis. Cardiac surgical procedures.

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Section: Discussionsupporting

confidence: 83%

Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas

Sá¹,

Silva

Lima³

et al. 2010

Rev Bras Cir Cardiovasc

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“…Un contrôle bactériologique répété permet de s'assurer de la négativation des liquides recueillis. Cette technique donne des résultats satisfaisants localement dans 80 à 90 % des cas [52][53][54]. C'est aussi la technique la moins traumatisante pour le malade et qui permet une mobilisation pré-coce.…”

Section: Le Volet Chirurgicalunclassified

“…Cette 20 technique, la première proposée historiquement, est encore utilisée. Même si elle permet un traitement rapide, son taux d'échec est élevé, jusqu'à 50 % des cas, notamment quand des greff ons mammaires ont été utilisés ou en cas de médiastinites tardives [52,53]. Elle nécessite une surveillance stricte des entrées et des sorties du système de drainage.…”

Section: Le Volet Chirurgicalunclassified

Infections postopératoires : médiastinites

Trouillet

2013

Références en Réanimation. Collection De La SRLF

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La médiastinite est une complication rare mais sévère de la chirurgie cardiaque eff ectuée par sternotomie. Cette infection associée aux soins se développe au niveau du médiastin antérieur et du sternum. En raison d'un choc septique ou mixte, ces patients peuvent nécessiter une prise en charge en réanimation. La proportion croissante d'opérés plus âgés ou avec des comorbidités multiples, fait que cette infection est encore associée à une mortalité élevée et à une prolongation de la durée d'hospitalisation. Défi nition, incidence, pathophysiologieLes médiastinites sont la forme la plus grave des infections du site opé-ratoire (ISO) qui incluent les infections superfi cielles, les ostéites sternales et les infections du médiastin antérieur [1,2]. Seules ces deux dernières correspondent stricto sensu à une médiastinite, encore désignée infection sternale profonde. Les malades hospitalisés en réanimation pour une mé-diastinite sont des patients qui ont bénéfi cié d'une reprise chirurgicale pour mise à plat de la plaie sternale [3]. Lors de cette mise à plat, le chirurgien a constaté un aspect patent d'infection avec la présence de pus et de tissus nécrotiques. Les cultures des prélèvements médiastinaux sont habituellement positives. L'incidence est généralement estimée entre 0,5 et 2 %, mais des écarts importants sont rapportés dans la littérature, compris entre 0,25 et 20 J.-L. Trouillet

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“…This therapy was adopted by several centers in Europe [87][88][89][90] and via humanitarian activities in Asia, South America and Africa.…”

Section: Treatmentmentioning

confidence: 99%

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

Durandy¹

2010

WJC

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In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.

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Comparison between closed drainage techniques for the treatment of postoperative mediastinitis

Cited by 70 publications

References 19 publications

Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas

Mediastinite no pós-operatório de cirurgia cardiovascular: análise de 1038 cirurgias consecutivas

Infections postopératoires : médiastinites

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

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