Mediastinitis in Emergency Medicine Follow-up

Updated: Feb 10, 2015
  • Author: James R Gardner, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Follow-up

Further Inpatient Care

As for any abscess, the essential management of this condition involves prompt and extensive surgical debridement. [8]

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 infections.

Lengthy hospitalization (≥1 month) is common.

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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.

Patients with mediastinitis 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.

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Complications

Complications of mediastinitis may include the following:

  • Death
  • Pericarditis
  • Sepsis
  • Multiorgan system failure
  • Adult respiratory distress syndrome
  • Cardiac tamponade
  • Empyema
  • Vascular thrombosis
  • Arterial hemorrhage via erosion of infection [3]
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Prognosis

Early diagnosis and aggressive therapy seem to provide the best chance for recovery.

Despite vast improvements in IV antibiotics, critical care medicine, and CT imaging in the last 30 years, mediastinitis still carries a high mortality rate. [4]

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