Dressings Indicated in the Treatment of Mediastinitis After Cardiac Surgery: Integrative Review

Abstract

Objective: identify and describe which dressings are recommended in the treatment of mediastinitis after cardiac surgery in adult patients. Method: integrative review held in the databases MEDLINE/PubMed, LILACS, CINAHL, Web of Science, Cochrane, SCOPUS and manual search, between December 2017 and January 2018. It was selected studies on dressings used in the treatment of mediastinitis after cardiac surgery. Results: eight articles were included: three addressed the treatment of negative pressure wounds and reported that most of the patients analyzed were successful in treatment, reducing the need for other interventions; four compared the previous therapy with conventional dressings and concluded that the rates of sternal reinfection and hospital mortality were lower in the first group; and one compared vacuum assisted therapy with a closed drainage system and lower rates of sternal reinfection were seen in the group undergoing vacuum treatment. Conclusion: the evidence indicates that the use of vacuum therapy to treat mediastinitis after cardiac surgery was effective. However, despite the positive outcome, clinical trials with strict methodological description and significant samples are suggested to minimize the risk of bias and to evaluate the impact of dressings in the treatment of mediastinitis.

Negative pressure wound therapy in the treatment of surgical site infection in cardiac surgery

“…It is noteworthy that a recent integrative review analyzing eight retrospective observational studies comparing the use of NPWT with conventional dressings to treat mediastinitis concluded that NPWT was superior to other technologies. NPWT contributed to increased healing speed and low rates of reinfection, mortality or hospital readmission (23) .…”

“…The World Health Organization (WHO) recommends only prophylactic use of NPWT to prevent SSI in previously closed, high-risk surgical incisions (22) . However, it is observed in clinical practice that the most frequent use of this technology is related to the treatment of SSI, although its use is supported by limited scientific evidence, especially for the treatment of SSI after cardiac surgery (23) . For this reason, its indication should be cautious due to the expensive device-related costs and the low quality of evidence (22) , leading to the need to explore the clinical outcomes of patients undergoing NPWT SSI treatment.…”

Reconstrução De Parede Torácica Anterior Pós Esternectomia Complicada - Relato De Caso

“…Segundo dia de pós operatório. Ferida sem sinais de sofrimento isquêmico, em bom aspecto profundidade da lesão etc (16,17) . Em um estudo realizado com 69 pacientes com mediastinite por esternotomia foi realizado o curativo em questão contra 49 pacientes que foram submetidos a tratamento convencional.…”

“…Observou-se de forma estatisticamente significativa que houve diminuição da taxa de mortalidade e da taxa de re-infecção no grupo que fez uso da terapia de pressão negativa (3) . Outro estudo realizado também entre 2018 -2019 nas bases de dados MEDLINE/PubMed, LILACS, CINAHL, Web of Science, Cochrane e SCOPUS sobre o mesmo tema também corrobora os mesmos resultados, indicando diminuição da mortalidade e de re-infecção da ferida (16) Portanto, conclui-se que a terapia por pressão negativa funciona como um mecanismo de ponte para acelerar a recuperação da ferida e diminuir suas complicações. No caso da mediastinite deve ser associada a antibioticoterapia guiada e múltiplos debridamentos em conjunto.…”

Terapia Da Ferida Por Pressão Negativa Versus Tratamento Convencional Em Cirurgia Vascular: Uma Revisão Da Literatura

“…A evolução na área de tratamento de feridas tem sido um evento complexo e dinâmico (Colares et al, 2019). Existe uma diversidade de pensos com diferentes ações terapêuticas, de modo a favorecer a granulação e epitelização dos tecidos (Frantz et al, 2019).…”