Clinical features of 5 patients with descending necrotizing mediastinitis originating from deep neck infection

Uwa, Nobuhiro; Terada, Tomonori; Saeki, Nobuo; Sagawa, Kousuke; Ogino, Kouichi; Sakagami, Masafumi

doi:10.1016/j.anl.2009.11.005

Cited by 14 publications

(21 citation statements)

References 7 publications

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“…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 ).…”

Section: Resultsmentioning

confidence: 99%

“…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 ).…”

Section: Discussionmentioning

confidence: 99%

“…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 …”

Section: Study Design: Systematic Review Of the Literaturementioning

confidence: 99%

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

2016

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Design: Systematic Review Of the Literaturementioning

confidence: 99%

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

2016

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“…Time is a determining factor in mediastinitis, and that's why a cervicothoracic CT scan is carried out in as soon as mediastinitis is suspected. Based on the CT findings, different treatments are necessary: for type I cases, cervicotomy and mediastinal drainage through the incision 4,5 or percutaneous drainage could be sufficient. For type II cases, even though there are groups that carry out sternotomy for cases of IIa, 7,16 the authors believe that it is appropriate to perform posterolateral thoracotomy in all cases, since the entire mediastinal cavity may be drained via the thoracotomy and the risk of osteonecrosis following sternotomy is avoided.…”

Section: Discussionmentioning

confidence: 99%

“…3 Mediastinitis may be classified into three types (Endo's classification), depending on the extent of the disease. 4 i) Type I: infection located above the carina. ii) Type II: infection extended below the carina.…”

Section: Introductionmentioning

confidence: 99%

Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

et al. 2011

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Acute mediastinitis is a life-threatening situation that is associated with high rates of morbidity and mortality. The most common causes of mediastinitis are: oesophageal perforation, acute necrotising mediastinitis (ANM) and post-sternotomy mediastinitis. The aim of this study was to analyze prognostic factors and the differences between mediastinitis from various origins. A retrospective analysis was carried out on all patients operated on for acute mediastinitis between 2000 and 2009. Surgical interventions were performed on 33 patients (69.7% male), the majority as a consequence of oesophageal perforation (21 cases). The overall mortality rate was 30%. Better survival was seen in subjects less than 60 years of age, subjects with no comorbidities, and subjects who had undergone early tracheotomy. Patients with ANM were younger, had less comorbidities, diagnosed later and required more repeat interventions compared to those patients who had mediastinitis caused by oesophageal perforations. Mortality was lower in the ANM group, but this was not statistically significant. Protective factors in mediastinitis are: early diagnostic and treatment, age under 60 years, absence of major comorbidity and early tracheotomy.

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Identification of risk factors for mortality and delayed oral dietary intake in patients with open drainage due to deep neck infections: Nationwide study using a Japanese inpatient database

et al. 2021

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Backgrounds: Data on risk factors for deep neck infection (DNI) including descending necrotizing mediastinitis (DNM) have been limited. Using a nationwide database, the aim was to identify the factors related to patient death and delay in recovering oral intake. Methods: We retrospective reviewed a Japanese inpatient database between 2012 and 2017, and data of 4,949 patients with DNM and DNI were extracted. The main outcome was survival at discharge. In a subgroup analysis of the 4,791 patients with survival at discharge, the second outcome was delay in the interval between admission and full recovery of oral intake. In both of the setting, logistic regression analyses were conducted to determine the risk factors. Results: Regarding survival at discharge, logistic regression analysis showed that age (≥75 years), comorbid diabetes mellitus, sepsis, receiving mechanical ventilation, and duration of empirical antibiotic therapy were signi cantly associated with mortality [adjusted-odds ratios (ORs) (95% con dence intervals (CIs)] as follows: 5.57 (2.80-11.1), 2.47 (1.69-3.62), 3.32 (2.29-4.82), 3.96 (2.51-6.23), and 1.00 (1.00-1.02), respectively. In a subgroup analysis of the 4,791 patients with survival at discharge, logistic regression analysis showed the following factors to be signi cantly associated with delayed oral dietary intake (>9 days), as follows [adjusted OR (95% CIs)]: age ≥75 years 1.89 (1.48-2.41); body mass index (

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Clinical features of 5 patients with descending necrotizing mediastinitis originating from deep neck infection

Cited by 14 publications

References 7 publications

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

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

Surgery for acute mediastinitis in oesophageal perforations and descending necrotising infection: complications, mortality and protective factors

Identification of risk factors for mortality and delayed oral dietary intake in patients with open drainage due to deep neck infections: Nationwide study using a Japanese inpatient database

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