2025/03/02 by Lourenço Marques, Davide, Bartolomeu, Francisca, Figueiredo, Hugo +4
#Descending necrotizing mediastinitis #transcervical drainage #transthoracic drainage #video-assisted thoracic surgery
paper · doi:10.34631/sporl.3061
Objectives: To describe the experience of approaching cases of Descending Necrotizing Mediastinitis (DNM) over the last 3 years in a tertiary hospital, addressing therapeutic approaches, results and complications. Methods: A descriptive retrospective study from November 2019 to December 2022, evaluating 7 patients diagnosed with DNM. Analysis included age, gender, disease subtype, clinical presentation, infection origin, comorbidities, surgical interventions, hospitalization duration, and isolated microorganisms. Results: All patients underwent surgery for drainage of collections and surgical debridement. The majority of patients (85.7%) underwent combined transcervical and transthoracic drainage. Only one patient underwent isolated transcervical surgical approach. Five cases (71.4%) required reoperation/surgical revision. Tracheostomy was performed in 57.1% of cases. The average hospitalization duration was 52.1 ± 33.6 days (range: 23-120 days), while the average intensive care unit stay was 22 ± 26.6 days (range: 2-77 days). No deaths occurred during hospitalization, and only one patient experienced complications, namely pneumonia and bilateral vocal cord immobility, requiring permanent tracheostomy. The remaining patients were discharged with a favorable outcome. Conclusion: To improve the prognosis of DNM, early and appropriate surgical debridement of affected areas, along with targeted antibiotics and/or antifungals, is essential. A multidisciplinary approach involving Cardiothoracic Surgery and Otolaryngology is indispensable for the treatment of this condition.