title: Efficacy and haemodynamic effects of vacuum-assisted closure for post-sternotomy mediastinitis in children.
abstract: OBJECTIVE
  Post-sternotomy mediastinitis is a significant morbidity with controversial management. Vacuum-assisted closure (VAC) has been used to treat mediastinitis, with many reports documenting its efficacy and feasibility, particularly in adults. However, its use is not prevalent in the paediatric population because of concerns that it may deteriorate haemodynamics. This study aimed to evaluate outcomes and effects of VAC on the haemodynamics of paediatric patients with post-sternotomy mediastinitis.
  
  
  METHODS
  Six patients were treated with VAC between April 2005 and March 2013. We retrospectively investigated their profiles, clinical outcomes and haemodynamic changes, including mean blood pressure (MBP), mean heart rate (MHR), urinary output, amount of diuretics and vasoactive-inotropic score (VIS), before and after VAC initiation.
  
  
  RESULTS
  The median age and body weight of patients were 6.4 months and 4.5 kg, respectively. Three patients (50%) had single ventricular physiology. The median VAC duration was 12 days. One patient died of pulmonary venous obstruction after mediastinitis was cured. The average MBPs in every 8-h period were examined, and there were no significant changes (P = 0.773); the average MHRs were examined in the same manner and they decreased significantly after initiation of VAC (P = 0.032). Only 2 patients required vasoactive agents. The VIS did not change in 1 patient and decreased in the other. The mean amount of diuretics administered and urinary output per body weight did not change significantly (P = 0.395 and 0.273, respectively).
  
  
  CONCLUSIONS
  In conclusion, the haemodynamics of children were not significantly affected by the negative pressure of VAC, indicating that this therapy may be safe and effective for post-sternotomy mediastinitis, even in small children with complex cardiac anomalies.
authors.affiliation: Department of Cardiovascular Surgery, Miyagi Children's Hospital, Sendai, Japan dr_takashin@hotmail.com takahara@med.tohoku.ac.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Takahara
authors.affiliation: Department of Cardiovascular Surgery, Miyagi Children's Hospital, Sendai, Japan.
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Sai
authors.affiliation: Department of Cardiovascular Surgery, Miyagi Children's Hospital, Sendai, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kagatani
authors.affiliation: Department of Cardiovascular Surgery, Miyagi Children's Hospital, Sendai, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Konishi
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects; D018579:Patient Selection; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D014662:Vasoconstrictor Agents
keywords: Circulatory haemodynamics; Congenital heart disease; Mediastinal infection; Paediatrics; Vacuum-assisted closure