Descending necrotizing mediastinitis below the tracheal carina

Abstract

In this low socioeconomic status patient population, descending necrotizing mediastinitis below the carina causes high morbidity and mortality, the latter particularly associated with age, complications, diabetes mellitus and other comorbidities.

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

“…Some authors suggest an increase in the incidence of descending necrotizing mediastinitis in recent years, confirmed in this study by the increased reports and cases in the recent series compared to the previous ones (evidence level III; Table ).…”

“…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 ).…”

“…In patients with deep neck infections, predisposing factors of mediastinal extension (incidence, 2.5%; range, 1.5% to 3.6%) were older age (+55 years; p < .001), the presence of comorbidities, such as diabetes ( p < .05), and the involvement of 2 or more spaces ( p < .05), including mainly the retropharyngeal space ( p < 01) (evidence level III).…”

“…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 …”