Our Summary

This research paper is about using a treatment method called Vacuum-assisted closure (VAC) to help children who develop a serious infection called mediastinitis after heart surgery. Mediastinitis is an infection in the middle part of the chest, which can be very dangerous and is hard to treat, especially in children.

The researchers looked back at the medical records of 14 children who had heart surgery and then developed mediastinitis. These children were all treated with VAC, which involves using a vacuum to help clean and heal the infected area, without needing to touch or wash the wound. The amount of vacuum pressure used was adjusted depending on how badly the chest bone was affected. The vacuum treatment was reduced and eventually stopped once the infection had cleared up.

The children in the study were, on average, around 7 months old and weighed around 5 kg. Most of them had infections caused by bacteria like staphylococcus and streptococcus, but other kinds of bacteria were also found. The vacuum treatment had to be changed about 4 times on average. The children stayed in hospital for about 50 days on average. One child needed additional surgery to close up the chest after the infection, and sadly two children did not survive.

The researchers concluded that VAC can be an effective treatment for mediastinitis in children after heart surgery. Traditional methods of cleaning and dressing the wound are not suitable in these cases.

FAQs

  1. What is Vacuum-assisted closure (VAC) and how does it help in treating mediastinitis in children?
  2. What were the results of the study on the use of VAC in children who developed mediastinitis after heart surgery?
  3. Why are traditional methods of cleaning and dressing the wound not suitable for treating mediastinitis in children after heart surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric cardiac surgery is to closely monitor the surgical incision for any signs of infection, such as redness, swelling, or drainage. If any of these symptoms occur, it is important to seek medical attention promptly to prevent complications like mediastinitis. Following post-operative care instructions carefully, including proper wound care and infection prevention measures, can help reduce the risk of complications and promote a successful recovery.

Suitable For

Patients who are typically recommended pediatric cardiac surgery include those with congenital heart defects, acquired heart conditions, or other heart abnormalities that require surgical intervention. These patients may include infants, children, and adolescents who have conditions such as atrial septal defects, ventricular septal defects, Tetralogy of Fallot, transposition of the great arteries, and other complex heart conditions. Patients with severe symptoms, progressive heart failure, or other complications may also be recommended for pediatric cardiac surgery. Additionally, patients who have previously undergone heart surgery and develop complications such as mediastinitis may also require pediatric cardiac surgery for treatment.

Timeline

Before pediatric cardiac surgery:

  • The patient undergoes pre-operative assessments, including physical exams, blood tests, and imaging studies to determine the best course of treatment.
  • The patient and their family meet with the surgical team to discuss the procedure, potential risks, and expected outcomes.
  • The patient may undergo additional tests and consultations to ensure they are healthy enough for surgery.
  • The patient is admitted to the hospital on the day of surgery and prepared for the procedure.

After pediatric cardiac surgery:

  • The patient is closely monitored in the intensive care unit (ICU) immediately after surgery for any complications.
  • The patient may need to stay in the hospital for several days to weeks to recover and receive post-operative care.
  • The patient may require additional treatments, such as medications, physical therapy, or follow-up appointments with the surgical team.
  • The patient and their family receive education on how to care for the surgical site and manage any potential complications.
  • The patient undergoes routine follow-up appointments to monitor their recovery and overall health.

In the case of mediastinitis after heart surgery:

  • The patient develops an infection in the middle part of the chest, which can be life-threatening if not treated promptly.
  • The patient is treated with VAC, a method that uses a vacuum to clean and heal the infected area without directly touching the wound.
  • The amount of vacuum pressure is adjusted based on the severity of the infection and the condition of the chest bone.
  • The patient undergoes multiple sessions of VAC treatment until the infection is cleared up.
  • The patient may require additional surgeries or interventions to fully recover from the infection.
  • The patient may need to stay in the hospital for an extended period of time to receive proper care and monitoring.
  • The patient and their family receive support and guidance throughout the treatment process to ensure the best possible outcome.

What to Ask Your Doctor

  1. What is mediastinitis and why is it a serious complication after pediatric cardiac surgery?
  2. How common is mediastinitis in children after heart surgery?
  3. What are the potential risks and benefits of using Vacuum-assisted closure (VAC) for treating mediastinitis in children?
  4. How does VAC therapy work and how is it different from traditional wound care methods?
  5. How is the amount of vacuum pressure determined for each individual case?
  6. What are the expected outcomes and recovery time for children undergoing VAC therapy for mediastinitis?
  7. Are there any potential long-term effects or complications associated with VAC therapy in children?
  8. What other treatment options are available for children with mediastinitis after heart surgery?
  9. How will the child’s progress be monitored during and after VAC therapy?
  10. Are there any additional precautions or care instructions that need to be followed at home after VAC therapy?

Reference

Authors: Onan IS, Yildiz O, Tüzün B, Timur B, Haydin S. Journal: Artif Organs. 2019 Feb;43(2):119-124. doi: 10.1111/aor.13321. Epub 2018 Oct 3. PMID: 30281163