Descending necrotizing mediastinitis: a modified algorithmic approach to define a new standard of care

Surgical Infections
Jonathan D'CunhaGregory J Beilman

Abstract

Descending necrotizing mediastinitis (DNM) is a highly morbid infectious process. This uncommon disease process has carried historically a substantial burden of morbidity and mortality. In this study we hypothesized that application of a prospective modified management algorithm would decrease the morbidity and mortality from this highly destructive process. We developed a systematic approach for managing DNM, focusing on serial debridement guided by imaging, in conjunction with the use of broad-spectrum antibiotics and modern principles of critical care. We reviewed all patients admitted with this disease process from 2007-2012. Data collected included demographic information, co-morbidities, laboratory data including culture results, operative details, imaging frequency and findings, complications, and survival. Continuous variables were reported as median values and ranges. From 2007-2010, we treated eight patients with DNM. The median age of the patients was 33 y (range 28-63 y), and 63% were male. In accordance with our algorithm, the patients underwent serial imaging at regular intervals following operative debridement. The median number of imaging studies was 11 (range 4-19). The patients required a median of five operat...Continue Reading

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Citations

Jan 14, 2016·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·B M BuchholzM Kaminski
Aug 12, 2016·Respirology Case Reports·Yusuke TakanashiKazuhito Funai
Jan 13, 2017·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Yasir Abu-OmarGiuseppe Cardillo

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