Surgical Management of Descending Necrotizing Mediastinitis

Descending necrotizing mediastinitis: Systematic review on its treatment in the last 6 years, 75 years after its description

“…We did not find randomized controlled trials or clinical practice guidelines published on the diagnosis and treatment of descending necrotizing mediastinitis; the best available evidence in adults was obtained from 26 published studies of clinical reviews of 4 or more cases of descending necrotizing mediastinitis with evidence level III (Table ).…”

“…This study is the first systematic review of the treatment of descending necrotizing mediastinitis in the last 6 years, which includes a series of 4 or more cases published from 2009 to 2014, comparing mortality with the published revisions of earlier periods, which shows a decline since the year 2000, which has been sustained to this date (Table ).…”

“…Drainage of the superior mediastinum by sternotomy, parasternal mediastinoscopy (Chamberlain), and mediastinoscopy, or minimally invasive thoracoscopic approaches have also been reported. In some cases of mediastinitis with anterior‐inferior extension (IIA), a subxiphoid incision has been used …”

“…We emphasize the need for the integration of a multidisciplinary team (dentist, infectious disease specialist, radiologist, intensivist, anesthesiologist, otolaryngologist, and thoracic surgeon) to standardize a protocol that allows a proper diagnosis and aggressive surgical treatment of the primary focus, neck and mediastinum, preferably within the first hours of the diagnosis, although there is still not enough evidence to establish what is the optimal time for surgical drainage of the mediastinum (recommendation grade C).…”

“…Isolated case reports or series with less than 4 cases of descending necrotizing mediastinitis, which have low evidence level (IV), were not included for the purpose of analysis in this review. Reports of descending necrotizing mediastinitis published before the year 2009 were also not included because there are reviews of accumulated cases from the period from 1969 to 1989, from 1970 to 1997, and from 1998 to 2008, along with 5 meta‐analysis of these periods; all other case series published between 2009 to 2014 were included …”