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Cardiothoracic Surgery |

Superior and Inferior Descending Necrotizing Mediastinitis, 100 Cases

Walid Dajer-Fadel, MD; Carlos Ibarra-Pérez, PhD; Juan Solís-Suárez, MD; Luis Sánchez-Velázquez, PhD; Carolina Tortolero-Sánchez, MD; Rafael Borrego-Borrego, MD; Francisco Navarro-Reynoso, MHA; Rubén Argüero-Sánchez, PhD
Author and Funding Information

General Hospital of Mexico, Mexico City, Mexico


Chest. 2013;144(4_MeetingAbstracts):117A. doi:10.1378/chest.1702088
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Abstract

SESSION TITLE: Unusual Problems and Thoracic Surgical Solutions

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: Descending necrotizing mediastinitis (DNM) is a disease with historical unfavorable prognosis. This study describes the varying characteristics of superior (SM) and inferior (IM) involvement in patients treated for this condition.

METHODS: We performed a descriptive, retrospective review of 100 patients with the SM and IM types in a seven year period, the largest study performed in the last 50 years. Demographic, clinical, para-clinical and therapeutical variables were analyzed with morbidity and mortality as primary end points. Statistics: descriptive and inferential (ANOVA and chi square). Significance was considered at a value of p = < 0.05.

RESULTS: Sixty four (64%) were male. The mean age was 43.1 ± 15.2 years old. Mean hospitalization time of 21.9 ± 17.7 days. Comorbidities were present in 62% of the patients, diabetes mellitus type 2 being the most common. Odontogenic abscesses occupied 44% of the cases as the main source of infection in DNM. The anterior mediastinum was affected in 74%, the middle and posterior were the most involved sites for IM (p = < 0.001). The majority of SM were secondary to peritonsillar (p = < 0.001) and for IM, retropharyngeal abscesses (p = 0.005). The most frequent complications were pneumonia, septic shock and oro-cutaneous fistulas. Tracheotomized patients (n = 74) had 23% association to pneumonia whilst non-tracheotomized (n = 26) had a 7.7% rate of pneumonia (p = 0.072). Microorganism cultures demonstrated 49% for Gram-negative, 27% for Gram-positive bacteria and 5% for fungal infections. Global mortality was 29%; SM represented 10.3% and IM 36.6% (p = 0.006).

CONCLUSIONS: In this sample size of low socio-economic status, IM represents an important risk factor for mortality, IM carries a greater burden on the patient`s immunologic and systemic inflammatory responses associated to mortality.

CLINICAL IMPLICATIONS: We consider that DNM should be subdivided and further studied in SM and IM since they represent clear differences in prognosis between one and another, guiding physicians to apply a more adequate treatment plan depending on the extension of the disease.

DISCLOSURE: The following authors have nothing to disclose: Walid Dajer-Fadel, Carlos Ibarra-Pérez, Juan Solís-Suárez, Luis Sánchez-Velázquez, Carolina Tortolero-Sánchez, Rafael Borrego-Borrego, Francisco Navarro-Reynoso, Rubén Argüero-Sánchez

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