eMedicine Specialties > Emergency Medicine > Infectious Diseases

Mediastinitis: Follow-up

Author: Ethan S Brandler, MD, MPH, Clinical Assistant Instructor, Staff Physician, Departments of Emergency Medicine and Internal Medicine, University Hospital of Brooklyn, Kings County Hospital
Coauthor(s): Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Apr 2, 2008

Follow-up

Further Inpatient Care

  • As for any abscess, the essential management of this condition involves extensive surgical debridement.
  • The use of hyperbaric oxygen for this condition is controversial.
  • Recent studies have looked at the use of intravenous immunoglobulins for mediastinitis, particularly when the condition arises as a complication of cardiothoracic surgery.
  • Broad-spectrum antibiotics are necessary. Antibiotics should be capable of treating aerobes, anaerobes, and gram-positive and gram-negative infection.

Transfer

  • Optimal treatment of this disease requires extensive surgical debridement. This may require the services of cardiothoracic surgeons and otorhinolaryngologists and may necessitate a transfer if these services are not available.
  • These patients often require highly skilled intensive care. Some patients may require referral to a tertiary care center if these resources are not available at the presenting hospital.

Complications

  • Pericarditis
  • Sepsis
  • Multiorgan system failure

Prognosis

  • This condition, once established, has a high mortality rate (up to 50%), despite intensive care management.
  • Early diagnosis and aggressive therapy seem to provide the best chance for recovery.

Miscellaneous

Medicolegal Pitfalls

  • Consider the possibility of mediastinitis if evidence indicates that gas is present in the soft tissues of the neck.
  • Consider a diagnosis of mediastinitis in patients with upper respiratory tract infections who present with signs or symptoms that appear to be out of proportion to the initial findings.

Special Concerns

  • If a patient has had recent cardiothoracic surgery, be sure to consider the possibility of a fungal etiology. Send blood for fungal cultures.
  • Most recommendations for therapy are based on retrospective case series, literature reviews, and personal experience.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Martin J Carey, MD, to the development and writing of this article.



More on Mediastinitis

Overview: Mediastinitis
Differential Diagnoses & Workup: Mediastinitis
Treatment & Medication: Mediastinitis
Follow-up: Mediastinitis
Multimedia: Mediastinitis
References
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Further Reading

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Keywords

descending necrotizing mediastinitis, oropharynx, oropharyngeal infection, mediastinum, mediastinitis, infection of the mediastinum, head and neck infection, head infection, neck infection

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Contributor Information and Disclosures

Author

Ethan S Brandler, MD, MPH, Clinical Assistant Instructor, Staff Physician, Departments of Emergency Medicine and Internal Medicine, University Hospital of Brooklyn, Kings County Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Eric Kardon, MD, FACEP, Associate Staff, Division of Emergency Medicine, Athens Regional Medical Center
Eric Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jeter (Jay) Pritchard Taylor III, MD, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina
Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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