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. 2023 Jul 12;18(1):229.
doi: 10.1186/s13019-023-02321-2.

Surgical management of descending necrotizing mediastinitis: strategy for thoracic interference

Lam Xuan Nhat  1 , Vu Huu Vinh  2 , Chau Phu Thi  1 , Nguyen Van Khoi  1
Affiliations

Surgical management of descending necrotizing mediastinitis: strategy for thoracic interference

Lam Xuan Nhat et al. J Cardiothorac Surg. .

Abstract

Background: The present descriptive study shares the overall experience of treating all these patients where different surgical process was adopted depending on the treatment required after carefully evaluating the risk factors and comorbidities.

Methods: The present study was conducted at the Department of Thoracic Surgery, Choray Hospital, Vietnam between the period of 2010 to 2020. We have treated 95 patients altogether in this duration.

Results: We were able to save most of the patients by applying thoracotomy and thoracic irrigation for most of the patients based on the observed indications that were identified immediately after the compulsory standard cervicotomy. The indication for thoracic interference was considered when the infection was deeply spread into the mediastinum and cannot get out through cervicotomy, although the most effective method of drainage was applied.

Conclusion: Our statistical investigation of the patient data suggested the possible association and influence of comorbidity such as diabetes. Therefore, we recommend that in specific cases thoracotomy along with thoracic irrigation and repetitive surgical draining could be a better option to reduce the infection and the mortality rate.

Trial registration: Retrospectively registered.

Keywords: DNM; Gauze packing; Mediastinitis; Pleural cavity irrigation; VATS.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Obtained example computed tomography (CT) Scan results for the patients. (A) The infectious fluid (2) surrounding the trachea spread below the innominate vein (1). (B) The infection (2) is in the upper mediastinum. (C) The infection spread just to the level of the innominate vein (1). (D) the infection (1) spread to the lower mediastinum (carina level) plus right pleural effusion (2)
Fig. 2
Fig. 2
(A) Gauze packing in the cervicotomy incision. (B) Irrigating (infusion) catheter (1) and drainage chest tube (2) after thoracic interference (thoracotomy or VATS).
Fig. 3
Fig. 3
Correlation analysis of the important parameters. Heatmap presentation of correlation analysis results for age, hospitalization days, teeth decay, diabetes, results of the procedure, and time of care
Fig. 4
Fig. 4
Pairwise T-test analysis of A age and diabetes, B age and hospitalization days, C age and surgical outcome or results, and D age and decay in teeth
See this image and copyright information in PMC

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