UNLABELLED: Descending necrotizing mediastinitis (DNM) is a serious disease of the mediastinum; early diagnosis and treatment may lower the high mortality rate of this disease. OBJECTIVE: To know the frequency of DNM in an intensive respiratory care unit. MATERIAL AND METHODS: This is a retrospective, transversal, and observational trial of a series of consecutive cases. In a period from January 1, 1990 to December 31, 2000, among 1,560 patients, we found 17 patients with DNM according with selection criteria. RESULTS: Fifteen males and two females, mean age 38.9 years SD +/- 14.5 years, were studied. In 10, tracheostomy was practiced previously. Seventeen cases had different kinds of previous abscesses, seven periodontal (47%), six retropharyngeal (35.5%), and four (23.5%) submaxillary. All cases were subject to thoracotomy. The most frequent postoperative complications were septic shock in 10 cases (58.8%), eight acute pulmonary damage (47%), six gastrointestinal bleeding (35.6%) and three acute respiratory insufficiency syndrome (11.6%). Seven deaths were registered and 10 patient survived. CONCLUSIONS: Statistical significance found between survival patients vs those who died was 31.9 +/- 8.6 vs 48.1 +/- 14.1 (p < 0.05) and in those with early tracheostomy 8.0 vs 28.6 (p = 0.68). Death occurred most frequently due to septic shock, specific mortality in this group of patients was 29%. Although DNM is a rare entity, 1.08% of all reviewed cases, must be treated immediately due to high mortality. The importance of early antimicrobial and surgical treatments is stressed.
UNLABELLED: Descending necrotizing mediastinitis (DNM) is a serious disease of the mediastinum; early diagnosis and treatment may lower the high mortality rate of this disease. OBJECTIVE: To know the frequency of DNM in an intensive respiratory care unit. MATERIAL AND METHODS: This is a retrospective, transversal, and observational trial of a series of consecutive cases. In a period from January 1, 1990 to December 31, 2000, among 1,560 patients, we found 17 patients with DNM according with selection criteria. RESULTS: Fifteen males and two females, mean age 38.9 years SD +/- 14.5 years, were studied. In 10, tracheostomy was practiced previously. Seventeen cases had different kinds of previous abscesses, seven periodontal (47%), six retropharyngeal (35.5%), and four (23.5%) submaxillary. All cases were subject to thoracotomy. The most frequent postoperative complications were septic shock in 10 cases (58.8%), eight acute pulmonary damage (47%), six gastrointestinal bleeding (35.6%) and three acute respiratory insufficiency syndrome (11.6%). Seven deaths were registered and 10 patient survived. CONCLUSIONS: Statistical significance found between survival patients vs those who died was 31.9 +/- 8.6 vs 48.1 +/- 14.1 (p < 0.05) and in those with early tracheostomy 8.0 vs 28.6 (p = 0.68). Death occurred most frequently due to septic shock, specific mortality in this group of patients was 29%. Although DNM is a rare entity, 1.08% of all reviewed cases, must be treated immediately due to high mortality. The importance of early antimicrobial and surgical treatments is stressed.