Postoperative mediastinitis in children: improvement of simple primary closed drainage.
BACKGROUND
Mediastinitis is a significant cause of postoperative morbidity. In 1989, we proposed simple primary closed drainage as a new treatment. Our goal is to describe improvements made to the original technique.


METHODS
After wound debridement, infected areas were drained with Redon catheters connected to strong negative-pressure drainage bottles. Mediastinal effluents were cultured every day, and the catheters were withdrawn when the effluent culture was negative for microorganisms. Patients were classified into three groups: isolated mediastinitis (group 1), mediastinitis associated with endocarditis (group 2), and mediastinitis associated with other organ failure (group 3).


RESULTS
Sixty-four patients were treated during a 10-year period: 15 neonates, 33 infants, and 16 children. Group 1 consisted of 40 patients. The time to mediastinal sterilization was 4 days (range, 1 to 14 days), and the antibiotic course was 11 days (range, 7 to 28 days), with a hospital stay of 13 days (range, 10 to 30 days). No deaths occurred in this group. Group 2 consisted of 7 patients. The time to mediastinal sterilization was 8 days (range, 3 to 10 days), and the antibiotic course was 30 days (range, 26 to 37 days), with a hospital stay of 37 days (range, 20 to 54 days). One patient in group 2 did not survive. Group 3 consisted of 17 patients. The time to mediastinal sterilization was 6 days (range, 1 to 10 days), and the antibiotic course was 15 days (range, 10 to 31 days), with a hospital stay of 20 days (range, 18 to 36 days). Two patients in group 3 did not survive. None of the deaths was directly related to mediastinitis, as the mediastinum was sterile in all 3 patients before death.


CONCLUSIONS
This simple treatment was efficient and reliable in achieving mediastinal sterilization. In addition, short antibiotic courses decreased restraint, which is poorly tolerated in pediatric patients.
Anslot
Christine
C
Intensive Care Unit of Pediatric Cardiac Surgery, Institut Jacques Cartier, Massy, France.
Hulin
Sylvie
S
Durandy
Yves
Y
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D004322:Drainage / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D011183:Postoperative Complications / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents