Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016)
Background: Mediastinitis is a potentially fatal condition. In addition to timely diagnosis, its prognosis depends on an early and systematic approach. Objective: To describe the results of mediastinitis treatment over a period of 34 years in a teaching hospital, its evolution and the current model...
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Permanyer
2017-10-01
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| Series: | Revista Médica del Hospital General de México |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0185106316301147 |
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| author | F.P. Navarro-Reynoso B. Vargas-Abrego A. Pérez-Romo R. Cicero-Sabido |
| author_facet | F.P. Navarro-Reynoso B. Vargas-Abrego A. Pérez-Romo R. Cicero-Sabido |
| author_sort | F.P. Navarro-Reynoso |
| collection | DOAJ |
| description | Background: Mediastinitis is a potentially fatal condition. In addition to timely diagnosis, its prognosis depends on an early and systematic approach. Objective: To describe the results of mediastinitis treatment over a period of 34 years in a teaching hospital, its evolution and the current model of care. Materials and methods: Cross-sectional, retrospective and descriptive study of patients with mediastinitis admitted from 1 June 1982 to 30 July 2016. The analysed variables were demographic, classification and aetiology of mediastinitis, comorbidities, complications, length of hospital and intensive care unit stay and mortality. Results: 1880 patients were included of which 1496 (79.6%) were men. The mean age was 39.4 ± 17.8 years. According to the classification of Endo, 603 (32.1%) corresponded to type I and 1277 (67.9%) to types IIA and IIB. According to the aetiology, in 910 cases the origin was odontogenic (48.4%), 526 due to retropharyngeal abscess (28%), 147 secondary to submandibular abscess (7.8%), 49 due to cervical lymphadenectomy (2.6%), 36 due to pharyngeal trauma (1.9%), 14 due to post-intubation tracheal rupture (0.7%) and 198 were of undetermined origin (10.6%). Mediastinotomy with right thoracotomy was performed in 86% and mediastinotomy with left thoracotomy was performed in 14%. Simultaneous tracheostomy was performed in 83% of cases, standardising this procedure since 2005. Mortality varied between periods and was 50% in 1982â1992, 41% in 1992â2001, 35% in 2002â2011 and 17% in 2012â2016. Conclusion: Along with the standardisation of the management of mediastinitis, a fall in mortality from this cause has been observed over the years. The maturity of the proposed model of care is a result of, among other things, medical and scientific advances and the experience gained in this pathology over more than three decades. Resumen: Antecedente: La mediastinitis es un padecimiento potencialmente fatal. Además del diagnóstico oportuno el pronóstico dependerá de un abordaje sistemático temprano. Objetivo: Describir los resultados del tratamiento de la mediastinitis en un periodo de 34 años en un hospital escuela, su evolución y el modelo de atención vigente. Material y métodos: Estudio retrospectivo, descriptivo y transversal de pacientes con mediastinitis ingresados del 1 de junio de 1982 al 30 de julio de 2016. Las variables que se analizan son demográficas, clasificación y etiologÃa de la mediastinitis, comorbilidades, complicaciones, dÃas de estancia en hospital y en terapia intensiva y mortalidad. Resultados: Se incluye a 1880 pacientes de los cuales 1496 (79.6%) fueron hombres. La edad promedio fue de 39.4 ± 17.8 años. Según la clasificación de Endo, 603 (32.1%) correspondieron al tipo I y 1277 (67.9%) a los tipos IIA y IIB. Según la etiologÃa, en 910 casos fue de origen ondotogénico (48.4%), 526 por absceso retrofarÃngeo (28%), 147 secundarios a absceso submandibular (7.8%), 49 a linfadenectomÃa cervical (2.6%), 36 a trauma farÃngeo (1.9%), 14 a ruptura traqueal postintubación (0.7%) y 198 de origen indeterminado (10.6%). Se realizó mediastinotomÃa con toracotomÃa derecha en 86% y con toracotomia izquierda en 14%. La traqueostomÃa simultánea se realizó en el 83% de los casos, estandarizándose desde el año 2005. La mortalidad varió por periodos siendo de 50% en 1982 a 1992, de 41% en 1992 a 2001, de 35% en 2002 a 2011 y de 17% en 2012 a 2016. Conclusión: A la par de una estandarización en el manejo de la mediastinitis, se observa un descenso en la mortalidad por esta causa con el pasar de los años. La madurez del modelo de atención que se propone responde entre otros a avances médico-cientÃficos y a la experiencia acumulada en esta patologÃa en más de tres décadas. Keywords: Mediastinitis, Thoracic surgery, Emergency surgery, Neck abscess, Palabras clave: Mediastinitis, CirugÃa de tórax, CirugÃa de urgencia, Absceso de cuello |
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| language | English |
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| spelling | doaj.art-55e20dce4a9746c88b30000cf5e1d44c2022-12-21T22:13:56ZengPermanyerRevista Médica del Hospital General de México0185-10632017-10-01804228232Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016)F.P. Navarro-Reynoso0B. Vargas-Abrego1A. Pérez-Romo2R. Cicero-Sabido3Pneumology and Thoracic Surgery Department, General Hospital of Mexico âDr. Eduardo Liceagaâ, Mexico City, Mexico; Secretary of Federal Health, Mexico City, Mexico; Corresponding author at: Servicio de NeumologÃa y CirugÃa de Tórax, Hospital General de México âDr. Eduardo Liceagaâ, Dr. Balmis 148, C.P. 06726, Mexico City, Mexico.Pneumology and Thoracic Surgery Department, General Hospital of Mexico âDr. Eduardo Liceagaâ, Mexico City, MexicoPneumology and Thoracic Surgery Department, General Hospital of Mexico âDr. Eduardo Liceagaâ, Mexico City, MexicoPneumology and Thoracic Surgery Department, General Hospital of Mexico âDr. Eduardo Liceagaâ, Mexico City, Mexico; Medicine Faculty, National Autonomous University of Mexico, Mexico City, MexicoBackground: Mediastinitis is a potentially fatal condition. In addition to timely diagnosis, its prognosis depends on an early and systematic approach. Objective: To describe the results of mediastinitis treatment over a period of 34 years in a teaching hospital, its evolution and the current model of care. Materials and methods: Cross-sectional, retrospective and descriptive study of patients with mediastinitis admitted from 1 June 1982 to 30 July 2016. The analysed variables were demographic, classification and aetiology of mediastinitis, comorbidities, complications, length of hospital and intensive care unit stay and mortality. Results: 1880 patients were included of which 1496 (79.6%) were men. The mean age was 39.4 ± 17.8 years. According to the classification of Endo, 603 (32.1%) corresponded to type I and 1277 (67.9%) to types IIA and IIB. According to the aetiology, in 910 cases the origin was odontogenic (48.4%), 526 due to retropharyngeal abscess (28%), 147 secondary to submandibular abscess (7.8%), 49 due to cervical lymphadenectomy (2.6%), 36 due to pharyngeal trauma (1.9%), 14 due to post-intubation tracheal rupture (0.7%) and 198 were of undetermined origin (10.6%). Mediastinotomy with right thoracotomy was performed in 86% and mediastinotomy with left thoracotomy was performed in 14%. Simultaneous tracheostomy was performed in 83% of cases, standardising this procedure since 2005. Mortality varied between periods and was 50% in 1982â1992, 41% in 1992â2001, 35% in 2002â2011 and 17% in 2012â2016. Conclusion: Along with the standardisation of the management of mediastinitis, a fall in mortality from this cause has been observed over the years. The maturity of the proposed model of care is a result of, among other things, medical and scientific advances and the experience gained in this pathology over more than three decades. Resumen: Antecedente: La mediastinitis es un padecimiento potencialmente fatal. Además del diagnóstico oportuno el pronóstico dependerá de un abordaje sistemático temprano. Objetivo: Describir los resultados del tratamiento de la mediastinitis en un periodo de 34 años en un hospital escuela, su evolución y el modelo de atención vigente. Material y métodos: Estudio retrospectivo, descriptivo y transversal de pacientes con mediastinitis ingresados del 1 de junio de 1982 al 30 de julio de 2016. Las variables que se analizan son demográficas, clasificación y etiologÃa de la mediastinitis, comorbilidades, complicaciones, dÃas de estancia en hospital y en terapia intensiva y mortalidad. Resultados: Se incluye a 1880 pacientes de los cuales 1496 (79.6%) fueron hombres. La edad promedio fue de 39.4 ± 17.8 años. Según la clasificación de Endo, 603 (32.1%) correspondieron al tipo I y 1277 (67.9%) a los tipos IIA y IIB. Según la etiologÃa, en 910 casos fue de origen ondotogénico (48.4%), 526 por absceso retrofarÃngeo (28%), 147 secundarios a absceso submandibular (7.8%), 49 a linfadenectomÃa cervical (2.6%), 36 a trauma farÃngeo (1.9%), 14 a ruptura traqueal postintubación (0.7%) y 198 de origen indeterminado (10.6%). Se realizó mediastinotomÃa con toracotomÃa derecha en 86% y con toracotomia izquierda en 14%. La traqueostomÃa simultánea se realizó en el 83% de los casos, estandarizándose desde el año 2005. La mortalidad varió por periodos siendo de 50% en 1982 a 1992, de 41% en 1992 a 2001, de 35% en 2002 a 2011 y de 17% en 2012 a 2016. Conclusión: A la par de una estandarización en el manejo de la mediastinitis, se observa un descenso en la mortalidad por esta causa con el pasar de los años. La madurez del modelo de atención que se propone responde entre otros a avances médico-cientÃficos y a la experiencia acumulada en esta patologÃa en más de tres décadas. Keywords: Mediastinitis, Thoracic surgery, Emergency surgery, Neck abscess, Palabras clave: Mediastinitis, CirugÃa de tórax, CirugÃa de urgencia, Absceso de cuellohttp://www.sciencedirect.com/science/article/pii/S0185106316301147 |
| spellingShingle | F.P. Navarro-Reynoso B. Vargas-Abrego A. Pérez-Romo R. Cicero-Sabido Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016) Revista Médica del Hospital General de México |
| title | Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016) |
| title_full | Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016) |
| title_fullStr | Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016) |
| title_full_unstemmed | Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016) |
| title_short | Mediastinitis, a model of care. Experience in the General Hospital of Mexico over 34 years (1982â2016) |
| title_sort | mediastinitis a model of care experience in the general hospital of mexico over 34 years 1982a2016 |
| url | http://www.sciencedirect.com/science/article/pii/S0185106316301147 |
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