Mediastinitis after pediatric cardiac surgery: a 15-year experience at a single institution

Tortoriello, Tia A.; Friedman, Jeffrey D.; McKenzie, E. Dean; Fraser, Charles D.; Feltes, Timothy F.; Randall, J.K.; Mott, Antonio R.

doi:10.1016/s0003-4975(03)01025-7

Cited by 85 publications

(79 citation statements)

References 28 publications

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“…to 2% of pediatric patients undergoing median sternotomy. [1][2][3][4][5][6][7] Pediatric cardiac surgery mortality is significantly increased by the development of mediastinitis, in one report from 5% to 35%. 8 Risk factors for development of mediastinitis in the pediatric population include young age, a higher American Society of Anesthesiologists (ASA) score, complex congenital heart lesions, hypothermia, hyperglycemia, and, in many reports, delayed sternal closure.…”

Section: Resultsmentioning

confidence: 99%

Rigid sternal fixation in the management of pediatric postmedian sternotomy mediastinitis: A 20-year study

Roughton¹,

Agarwal

Song

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Section: Resultsmentioning

confidence: 99%

Rigid sternal fixation in the management of pediatric postmedian sternotomy mediastinitis: A 20-year study

Roughton¹,

Agarwal

Song

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…The incidence rate of mediastinitis has been reported to be 0.3-5% [7][8][9][10]. Mediastinitis after sternotomy is a severe complication, even in paediatric patients, and its treatment remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Takahara

Kagatani

et al. 2014

Interact CardioVasc Thorac Surg

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OBJECTIVES: Post-sternotomy mediastinitis is a significant morbidity with controversial management. Vacuum-assisted closure (VAC) has been used to treat mediastinitis, with many reports documenting its efficacy and feasibility, particularly in adults. However, its use is not prevalent in the paediatric population because of concerns that it may deteriorate haemodynamics. This study aimed to evaluate outcomes and effects of VAC on the haemodynamics of paediatric patients with post-sternotomy mediastinitis. METHODS:Six patients were treated with VAC between April 2005 and March 2013. We retrospectively investigated their profiles, clinical outcomes and haemodynamic changes, including mean blood pressure (MBP), mean heart rate (MHR), urinary output, amount of diuretics and vasoactive-inotropic score (VIS), before and after VAC initiation. RESULTS:The median age and body weight of patients were 6.4 months and 4.5 kg, respectively. Three patients (50%) had single ventricular physiology. The median VAC duration was 12 days. One patient died of pulmonary venous obstruction after mediastinitis was cured. The average MBPs in every 8-h period were examined, and there were no significant changes (P = 0.773); the average MHRs were examined in the same manner and they decreased significantly after initiation of VAC (P = 0.032). Only 2 patients required vasoactive agents. The VIS did not change in 1 patient and decreased in the other. The mean amount of diuretics administered and urinary output per body weight did not change significantly (P = 0.395 and 0.273, respectively). CONCLUSIONS:In conclusion, the haemodynamics of children were not significantly affected by the negative pressure of VAC, indicating that this therapy may be safe and effective for post-sternotomy mediastinitis, even in small children with complex cardiac anomalies.

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“…Mediastinitis is a complication of pediatric cardiac surgery, with an incidence of 0.2% to 5% [1][2][3] . It is a retrosternal wound infection frequently associated with a macroscopically sternal osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

“…The goal of this manuscript is to describe the different suggestions that have been offered: (1) to prevent medi-astinitis; (2) to confirm the diagnosis of mediastinitis; and (3) to treat poststernotomy deep wound infection. We will especially focus on an original and simple closed chest technique that we described in 1989 [4] and reevaluated in 2007 [5] .…”

Section: Introductionmentioning

confidence: 99%

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

Durandy¹

2010

WJC

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In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.

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Mediastinitis after pediatric cardiac surgery: a 15-year experience at a single institution

Cited by 85 publications

References 28 publications

Rigid sternal fixation in the management of pediatric postmedian sternotomy mediastinitis: A 20-year study

Rigid sternal fixation in the management of pediatric postmedian sternotomy mediastinitis: A 20-year study

Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

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