Evolução clínica de pacientes com mediastinite pós-cirurgia de revascularização miocárdica submetidos à oxigenoterapia hiperbárica como terapia adjuvante

Egito, Julyana Galvão Tabosa do; Abboud, Cely Saad; Oliveira, Aline Pâmela Vieira de; Máximo, Carlos Alberto Gonçalves; Montenegro, Carolina Moreira; Amato, Vivian Lerner; Bammann, Roberto; Farsky, Pedro Sílvio

doi:10.1590/s1679-45082013000300014

Cited by 12 publications

(11 citation statements)

References 13 publications

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“…The incidence of postoperative DSWJ after cardiac surgery is rather low and ranges from 0.5% to 5.3% [ 1 – 4 , 11 , 12 ]. However, DSWI is one of the most serious complications, significantly increasing postoperative mortality, morbidity, time of hospitalization, hospital costs and need for surgical re-intervention [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Current paradigms in the management of sternal wound infection include surgical debridement, vacuum-assisted closure therapy, flap coverage, and sternal plating [ 18 ]. Unfortunately, in the available literature there is still insufficient information about hyperbaric oxygen therapy as an alternative treatment option in DSWI [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, there are no guidelines or official clinical indications of HBO2 therapy in DSWI. There are only a few cases reports [ 2 , 25 , 26 ] and no randomized controlled trials [ 1 , 27 , 28 ] to support or reject the use of HBO2 in DSWI. Most of the published articles present level V evidence, which provides weak evidence to support the use of HBO2 in treatment, although the obtained results are encouraging [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Deep sternal wound infection (DSWI) is one of the most serious complications after cardiac surgery procedures. According to the literature, frequency of DSWI after cardiac surgery is from 0.5% to 5.3% with the early in hospital mortality range from 10% to 47% [ 1 – 4 ]. Deep sternal wound infection also increases the length of hospital stay, short- and long-term morbidity and medical costs [ 1 , 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections – a single center’s experience

Litwinowicz¹,

Bryndza²,

Chrapusta³

et al. 2016

kitp

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IntroductionDeep sternal wound infection (DSWI) is one of the most serious complications after cardiac surgery procedures, observed in 5% of patients. Current standard medical therapy for DSWI includes antibiotics, surgical debridement, resuturing or negative pressure wound therapy (NPWT). Unfortunately, in some cases these methods are insufficient, and additional therapeutic options are needed.AimTo assess the effects and usefulness of additional hyperbaric oxygen therapy (HBO2) in patients with DSWI after cardiac surgery procedures.Material and methodsA retrospective analysis of 10 patients after cardiac surgery who developed DSWI in the period 2010–2012 was performed. After 3 months of ineffective conventional therapy including targeted antibiotic, surgical sternal debridement and NPWT, patients were qualified for additional HBO2 therapy. A total of 20 sessions of HBO2 therapy were performed, each 92 minutes long.ResultsAfter 4 weeks of HBO2 treatment, 7 patients presented complete wound healing with fibrous scar formation. One patient was qualified for the another cycle of HBO2 therapy with 20 additional sessions, and complete wound healing was observed. In 2 cases, after 5 and 19 sessions, HBO2 was interrupted because of improper qualifications.ConclusionsThe HBO2 as an additional therapy in DSWI was successful in 80% of cases, and no complications were observed. However, due to the small number of published studies with a small number of patients, randomized, clinical trials are needed to assess the clinical results of HBO2 in DSWI after cardiac surgery procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections – a single center’s experience

Litwinowicz¹,

Bryndza²,

Chrapusta³

et al. 2016

kitp

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“…An experimental rat model found that tigecycline was significantly superior to vancomycin in this application [ 15 ] . HBO has become a focus of interest for mediastinitis treatment in recent years; however, the patient numbers in both experimental and prospective randomised studies are insufficient [ 16 ] .…”

Section: Introductionmentioning

confidence: 99%

Adjunctive hyperbaric oxygen therapy or alone antibiotherapy? Methicillin Resistant staphylococcus aureus mediastinitis in a rat model

Kurt¹,

Vural²,

Temız³

et al. 2015

Brazilian Journal of Cardiovascular Surgery

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OBJECTIVE In the post-sternotomy mediastinitis patients, Staphylococcus aureus is the pathogenic microorganism encountered most often. In our study, we aimed to determine the efficacy of antibiotic treatment with vancomycin and tigecycline, alone or in combination with hyperbaric oxygen treatment, on bacterial elimination in experimental S. aureus mediastinitis.METHODS Forty-nine adult female Wistar rats were used. They were randomly divided into seven groups, as follows: non-contaminated, contaminated control, vancomycin, tigecycline, hyperbaric oxygen, hyperbaric oxygen + vancomycin and hyperbaric oxygen + tigecycline. The vancomycin rat group received 10 mg/kg/day of vancomycin twice a day through intramuscular injection. The tigecycline group rats received 7 mg/kg/day of tigecycline twice a day through intraperitoneal injection. The hyperbaric oxygen group underwent 90 min sessions of 100% oxygen at 2.5 atm pressure. Treatment continued for 7 days. Twelve hours after the end of treatment, tissue samples were obtained from the upper part of the sternum for bacterial count assessment.RESULTS When the quantitative bacterial counts of the untreated contaminated group were compared with those of the treated groups, a significant decrease was observed. However, comparing the antibiotic groups with the same antibiotic combined with hyperbaric oxygen, there was a significant reduction in microorganisms identified (P<0.05). Comparing hyperbaric oxygen used alone with the vancomycin and tigecycline groups, it was seen that the effect was not significant (P<0.05).CONCLUSION We believe that the combination of hyperbaric oxygen with antibiotics had a significant effect on mediastinitis resulting from methicillin-resistant Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus mediastinitis can be treated without requiring a multidrug combination, thereby reducing the medication dose and concomitantly decreasing the side effects.

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Post-surgical mediastinitis due to carbapenem-resistant Enterobacteriaceae: Clinical, epidemiological and survival characteristics

Abboud

Monteiro

Stryjewski

et al. 2016

International Journal of Antimicrobial Agents

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Evolução clínica de pacientes com mediastinite pós-cirurgia de revascularização miocárdica submetidos à oxigenoterapia hiperbárica como terapia adjuvante

Cited by 12 publications

References 13 publications

Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections – a single center’s experience

Hyperbaric oxygen therapy as additional treatment in deep sternal wound infections – a single center’s experience

Adjunctive hyperbaric oxygen therapy or alone antibiotherapy? Methicillin Resistant staphylococcus aureus mediastinitis in a rat model

Post-surgical mediastinitis due to carbapenem-resistant Enterobacteriaceae: Clinical, epidemiological and survival characteristics

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