Acute Mediastinitis: Eight Years Retrospective on Critical Care Management Mediastinite Aguda: Estudo Retrospetivo de 8 Anos de Abordagem em Cuidados Intensivos

Abstract

Introduction: Acute mediastinitis is an inflammatory process of the mediastinum. It is an unusual disease that if not diagnosed and treated promptly can have a high mortality rate. The aim of this study was to review all the acute mediastinitis patients admitted to our Intensive Care Units, focusing on demographics; etiology; management - diagnostic tests and treatment; mortality.
Material and Methods: Retrospective descriptive study of all the patients admitted to our Intensive Care Units, between 1 April 1996 and 31 December 2014 discharge with a diagnosis of mediastinitis.
Results: We evaluated 13 patients, 54% (n=7) female, with median age 69 years. The etiologies were: esophageal perforation (n=5); descending necrotizing mediastinitis (n=5); secondary to an infection originating at another site (n=2); post-cardiothoracic surgery (n=1). At Intensive Care Units admission, 38% were in sepsis; and 38% were in septic shock. All performed computed tomography (n=13). All were treated with antibiotherapy, 85% were submitted to surgery and 15% to minimally-invasive procedures. Most complications were located to lung and pleural space (n=7). Two deaths were registered.
Conclusion: Our series differs from the reported literature regarding demographics (mostly female and with a higher age range) and etiology (esophageal perforation and descending necrotizing mediastinitis). For successive management it is of paramount importance to achieve an early diagnosis and treatment in Intensive Care Units due to its severity, complexity, and multiplicity of care needed.