Kardiyak Cerrahi Sonrası Postoperatif Mediastinit Tedavisi Sonuçları: Yıkamalı ve Yıkamasız Metodlarla Yapılan Negatif Basınçlı Yara Tedavilerinin Karşılaştırılması

Year 2022, , 62 - 67, 01.03.2022

Erhan Hafız , Özgür Altınbaş

https://doi.org/10.26453/otjhs.1011894

Abstract

Amaç: Kalp cerrahisi sonrası gelişen mediastinit potansiyel olarak yıkıcı bir komplikasyondur. Bu klinik durum için çeşitli tedavi modaliteleri önerilmiştir ve vakum yardımlı kapatma bunlardan biridir. Bu çalışmada yıkamalı ve yıkamasız yöntemlerle gerçekleştirilen vakum destekli kapatmanın sonuçlarını karşılaştırmayı amaçlanmıştır.
Materyal ve Metot: Ocak 2015-Haziran 2019 tarihleri ​​arasında sternotomi ile kalp cerrahisi gerçekleştirilen ve sonrasında mediastinit gelişen toplam 60 hasta çalışmaya dahil edildi. Grup 1 ve Grup 2, sırası ile yıkamasız ve yıkamalı negatif basınçlı yara tedavisi uygulanan 30 hastadan oluşturuldu. Gruplar arasında demografik özellikler ve tedavi sonuçları karşılaştırıldı.
Bulgular: Hastaların demografik verileri benzerdi. Bakteriyolojik kültürler, her iki gruptaki hastaların büyük çoğunluğunda stafilokok varlığını gösterdi (Grup 1, %61,6; Grup 2, %70). Tedavi, enfeksiyon eradikasyonu, yara kapanma ve hasta taburculuğu süreleri Grup 2'de istatistiksel olarak daha düşüktü (p<0,05) Yara kapanma oranı Grup 2'de istatistiksel olarak daha yüksekti (p<0,05).
Sonuç: Yıkama metodu kullanılarak uygulanan vakum destekli negatif basınç tedavisi, mediastinit tedavisinde uygulanabilen bir yöntemdir ve yıkamasız yönteme göre üstünlükleri mevcuttur. 

Keywords

Enfeksiyon, mediastinit, negatif basınçlı yara tedavisi, vakum yardımlı kapatma, yara iyileşmesi

Supporting Institution

YOK

Treatment Outcomes of Postoperative Mediastinitis After Cardiac Surgery: A Comparison of Negative Pressure Wound Therapy Performed with Instillation Method and Non-Instillation Method

Abstract

Objective: Mediastinitis following cardiac surgery is potentially devastating complication. Various treatment modalities were suggested for this clinical situation and vacuum assisted closure is one of them. In the study it was aimed to compare outcomes of vacuum assisted closure performed with instillation and non-instillation methods.
Materials and Methods: From January 2015 to June 2019, a total of 60 patients who had mediastinitis after cardiac surgery performed via sternotomy were included to the study. Both Group 1 and Group 2 was consisted of 30 patients to whom negative pressure wound therapy performed without and with instillation, respectively. Demographic characteristics and treatment outcomes were compared between the groups.
Results: Demographic data of the patients were similar. Bacteriologic cultures showed the presence of staphylococci in the majority of the patients in both groups (Group 1, 61.6%; Group 2, 70%). Duration of treatment, eradication of the infection, wound closure and patients discharge were statistically lower in Group 2 (p<0.05). Rate of the patients with healed wound was statistically significantly higher in Group 2 (p<0.05).
Conclusion: Vacuum assisted negative pressure therapy via instillation is a reliable method that can be performed in the treatment of mediastinitis and has superiority over non-instillation method. 

Keywords

Infection, mediastinitis, negative pressure wound therapy, vacuum-assisted closure, wound healing, Infection, mediastinitis, negative pressure wound therapy, vacuum-assisted closure, wound healing, Infection, mediastinitis, negative pressure wound therapy, vacuum-assisted closure, wound healing

References

• Ma JG, An JX. Deep sternal wound infection after cardiac surgery: a comparison of three different wound infection types and an analysis of antibiotic resistance. J Thorac Dis. 2018;10(1):377-387. doi:10.21037/jtd.2017.12.109
• Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg. 2001;20:1168-1175. doi:10.1016/s1010-7940(01)00991-5
• Lepelletier D, Bourigault C, Roussel JC, et al. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect. 2013;43:403-409. doi:10.1016/j.medmal.2013.07.003
• Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med. 2015;4(4):265-273. doi:10.5492/wjccm.v4.i4.265
• Kim PJ, Attinger CE, Steinberg JS, et al. The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg. 2014;133(3):709-716. doi:10.1097/01.prs.0000438060.46290.7a
• Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250-278.
• El Oakley RM, Wright JE. Postoperative mediastinitis: classification and management. Ann Thorac Surg. 1996;61(3):1030-1036. doi:10.1016/0003-4975(95)01035-1
• Abu-Omar Y, Kocher GJ, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017;51:10-29. doi:10.1093/ejcts/ezw326
• Fowler VG, O’brien SM, Muhlbaier LH, Corey GR, Ferguson TB, Peterson ED. Clinical predictors of major infections after cardiac surgery. Circulation. 2005;112(9 Suppl):1358-1365. doi:10.1161/CIRCULATIONAHA.104.525790
• Ruka E, Dagenais F, Mohammedi S, et al. Bilateral mammary artery grafting increases postoperative mediastinitis without survival benefit in obese patients. Eur J Cardiothorac Surg. 2016;50(6):1188-1195. doi:10.1093/ejcts/ezw164
• Mekontso-Dessap A, Kirsch M, Brun-Buisson C, Loisance D. Poststernotomy mediastinitis due to Staphylococcus aureus: Comparison of methicillin-resistant and methicillin-susceptible cases. Clin Infect Dis. 2001;32:877-883.  doi:10.1086/319355
• Kreter B, Woods M. Antibiotic prophylaxis for cardiothoracic operations: Metaanalysis of thirty years of clinical trials. J Thorac Cardiovasc Surg. 1992;104:590-599.
• Petzina R, Hoffmann J, Navasardyan A, et al. Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sterna re-infection rate compared to conventional treatment. Eur J Cardiothorac Surg. 2010;38(1):110-113. doi:10.1016/j.ejcts.2010.01.028
• Gregor S, Maegele M, Sauerland S, Krahn JF, Peinemann F, Lange S. Negative pressure wound therapy: a vacuum of evidence? Arch Surg. 2008;143(2):189-196. doi:10.1001/archsurg.2007.54
• Orgill D, Bayer L. Update on negative-pressure wound therapy. Plast Reconstr Surg. 2011;127:105-115. doi:10.1097/PRS.0b013e318200a427
• Sjögren J, Malmsjö M, Gustafsson R, Ingemansson R. Poststernotomy mediastinitis: A review of conventional surgical treatments, vacuum-assisted closures therapy and presentation of Lund University Hospital mediastinitis algorithm. Eur J Cardiothorac Surg. 2006;30:898-905. doi:10.1016/j.ejcts.2006.09.020
• Kaul P. Sternal reconstruction after post sternotomy mediastinitis. J Cardiothorac Surg. 2017;12:94-103. doi:10.1186/s13019-017-0656-7
• Lazar HL, VanderSalm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sterna wound infections. J Thorac Cardiovasc Surg. 2016;152(4):962-972. doi:10.1016/j.jtcvs.2016.01.060
• Teot L, Boissiere F, Fluieraru S. Novel foam dressing using negative pressure wound therapy with instillation to remove thick exudate. Int Wound J. 2017;14(5):842-848. doi:10.1111/iwj.12719
• Chowdhry SA, Wilhelmi BJ. Comparing negative pressure wound therapy with instillation and conventional dressings for sternal wound reconstruction. Plast Reconstr Surg Glob Open. 2019;71:e2087. doi:10.1097/GOX.0000000000002087
• Singh H, Mahendru S, Khazanchi RK. Negative pressure wound therapy with instillation on sterna wound: is it really worrisome? Ind J Thorac Cardiovasc Surg. 2019;34(4):594-595. doi:10.1007/s12055-019-00834-x
• Karaca S, Kalangos A. Vacuum-assisted closure (VAC)-Instill with continuous irrigation for the treatment of Mycobacterium hominis mediastinitis. Int Wound J. 2015;12:595-597. doi:10.1111/iwj.12234
• Gabriel A, Shores J, Bernstein B, et al. A clinical review of infected wound treatment with Vacuum Assisted ®(V.A.C.®) Therapy: experience and case series. Int Wound J 2009;6:1-25. doi:10.1111/j.1742-481X.2009.00628.x
• Hehr JD, Hodson TS, West JM, et al. Instillation negative pressure wound therapy: An effective approach for hardware salvage. Int Wound J. 2020;17(2):387-393. doi:10.1111/iwj.13283
• Gabriel A, Kahn K, Karmy-Johnes R. Use of negative pressure wound therapy with automated instillation for the treatment of extremity and trunk wounds: clinical outcomes and potential cost-effectiveness. Eplasty. 2014;14:e41.
• Gilbert V, Kelly T, Grossi R. Source control and graft preservation using negative pressure wound therapy with antibiotic instillation. Cureus. 2016;8(10):e855. doi:10.7759/cureus.855
• Gabriel A, Shores J, Heinrich C, et al. Negative pressure wound therapy with instillation: a pilot study describes a new method for treating infected wounds. Int Wound J. 2008;5:339-413. doi:10.1111/j.1742-481X.2007.00423.x