Our Summary

This research paper discusses mediastinitis, a serious and potentially deadly complication that can occur after a certain type of chest surgery (median sternotomy). Despite medical advancements, mediastinitis still occurs in 0.25-5% of cases. It can also be caused by infections from nearby structures like the esophagus, airways, and lungs, or from infections that descend from the head and neck. There is also a chronic form of mediastinitis, typically caused by granulomatous infections. The paper reviews the evidence for various prevention and treatment strategies with the goal of reducing the occurrence of mediastinitis and improving the ways it’s managed.

FAQs

  1. What is mediastinitis and what causes it?
  2. How often does mediastinitis occur after chest surgery?
  3. What are some of the prevention and treatment strategies reviewed in the paper for reducing the occurrence of mediastinitis?

Doctor’s Tip

After thoracic surgery, it is important to follow your doctor’s instructions for proper wound care and to prevent infections. Make sure to keep your incision site clean and dry, and watch for any signs of infection such as increased redness, swelling, or drainage. It is also important to avoid activities that could strain your chest muscles and slow down the healing process. Follow up with your doctor regularly to monitor your recovery progress and address any concerns you may have.

Suitable For

Patients who are typically recommended for thoracic surgery include those with:

  1. Lung cancer: Thoracic surgery may be recommended for patients with early-stage lung cancer to remove the tumor and surrounding tissue.

  2. Esophageal cancer: Surgery may be recommended for patients with esophageal cancer to remove the tumor and any affected surrounding tissue.

  3. Chest wall tumors: Thoracic surgery may be recommended for patients with tumors in the chest wall to remove the tumor and any affected surrounding tissue.

  4. Thoracic outlet syndrome: Surgery may be recommended for patients with thoracic outlet syndrome to relieve compression of the nerves and blood vessels in the thoracic outlet.

  5. Lung infections: Thoracic surgery may be recommended for patients with severe lung infections that do not respond to other treatments.

  6. Chest trauma: Thoracic surgery may be recommended for patients with severe chest trauma, such as a punctured lung or fractured ribs.

  7. Pleural effusion: Thoracic surgery may be recommended for patients with recurrent pleural effusion to drain fluid from the chest cavity.

  8. Chest wall deformities: Thoracic surgery may be recommended for patients with chest wall deformities, such as pectus excavatum or pectus carinatum, to correct the deformity.

Overall, patients who are recommended for thoracic surgery are those who have conditions that require surgical intervention to improve their quality of life, relieve symptoms, and potentially cure or manage their underlying condition.

Timeline

Before thoracic surgery:

  1. Consultation with a thoracic surgeon to discuss the need for surgery and potential risks and benefits.
  2. Pre-operative evaluation including blood tests, imaging studies, and possibly a bronchoscopy.
  3. Preparing for surgery by following any pre-operative instructions provided by the surgeon, such as fasting before surgery.
  4. Anesthesia induction and positioning on the operating table for the surgery.

After thoracic surgery:

  1. Recovery in the post-anesthesia care unit (PACU) with close monitoring of vital signs and pain management.
  2. Transfer to a hospital room for further recovery, usually in the intensive care unit (ICU) for close monitoring.
  3. Pain management and physical therapy to promote healing and prevent complications like pneumonia or blood clots.
  4. Discharge from the hospital with instructions for at-home care, including wound care and follow-up appointments with the surgeon.
  5. Long-term recovery and rehabilitation to regain strength and function, with potential complications like mediastinitis requiring additional treatment.

In the case of mediastinitis, a patient may experience symptoms such as fever, chest pain, and difficulty breathing after thoracic surgery. Diagnosis often involves imaging studies like CT scans or MRIs, and treatment may include antibiotics, drainage of infected fluid, and sometimes surgical debridement of infected tissue. Recovery from mediastinitis can be prolonged and may require additional hospitalization and follow-up care to ensure healing and prevent recurrence.

What to Ask Your Doctor

  1. What is the specific procedure you will be performing on my thoracic region?
  2. What are the potential risks and complications associated with this surgery, including the risk of mediastinitis?
  3. How can I best prepare for this surgery, both physically and mentally?
  4. What is the expected recovery time and rehabilitation process after the surgery?
  5. What are the signs and symptoms of mediastinitis that I should watch out for post-surgery?
  6. What measures will be taken to prevent mediastinitis during and after the surgery?
  7. How will mediastinitis be diagnosed and treated if it were to occur?
  8. Are there any lifestyle changes or precautions I should take after the surgery to reduce the risk of mediastinitis?
  9. What follow-up appointments and monitoring will be necessary after the surgery?
  10. Are there any alternative treatments or procedures that could reduce the risk of mediastinitis in my case?

Reference

Authors: Abu-Omar Y, Kocher GJ, Bosco P, Barbero C, Waller D, Gudbjartsson T, Sousa-Uva M, Licht PB, Dunning J, Schmid RA, Cardillo G. Journal: Eur J Cardiothorac Surg. 2017 Jan;51(1):10-29. doi: 10.1093/ejcts/ezw326. PMID: 28077503