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Safe and effective mediastinal drainage along the carotid sheath for septic mediastinitis

Summary

Mediastinitis is still a challenging condition, which can easily result in lethal sepsis. We previously reported parasternal anterior mediastinal drainage. In this congress, we will present another method of mediastinal drainage along the carotid sheath around the aortic arch approach without thoracotomy (oblique cervical incision, exposed carotid sheath, and bluntly dissected and inserted drainage tube along the carotid sheath reaching to the aortic arch). Three patients were treated by this procedure.

Introduction

Mediastinitis is still a challenging condition, which can easily result in severe lethal sepsis. It is important for management of mediastinitis to perform an effective and noninvasive drainage. We reported the 'parasternal anterior approach' as a method of mediastinal drainage for mediastinitis around the superior caval vein. In this congress we will present another method of mediastinal drainage for the septic mediastinitis around the aortic arch by the 'along carotid-sheath approach' without thoracotomy. The aim of this presentation is to clarify the usefulness and safety of this method.

Patients and surgical procedure

Three patients with septic mediastinitis were treated by this procedure. We drained the upper mediastinum from the supraclavicular pouch along the neck vessels, or the carotid sheath, by blunt dissection. We performed at first an oblique cervical incision, exposed the carotid sheath, and bluntly dissected and inserted a drainage tube along the carotid sheath reaching to the aortic arch. The neck and chest CT revealed that the drainage tube reached the aortic arch in two cases. The inflammatory signs of these two patients were improved after this procedure and repeated neck and chest CT revealed improvement of mediastinitis. No complications such as vascular injury related with this procedure was seen. The other case underwent this procedure when sepsis was already uncontrollable and died due to uncontrollable sepsis. The report of her autopsy showed the position of drain in the level of the aortic arch in front of the esophagus without any vascular injury and mediastinitis localized within the upper mediastinum.

Conclusion

Our method of mediastinal drainage, the 'along carotid-sheath approach', is useful, safe, and a minimal invasive procedure for septic patients with mediastinitis.

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Moriwaki, Y., Sugiyama, M., Yoshida, K. et al. Safe and effective mediastinal drainage along the carotid sheath for septic mediastinitis. Crit Care 7, P029 (2003). https://doi.org/10.1186/cc1918

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  • DOI: https://doi.org/10.1186/cc1918

Keywords

  • Aortic Arch
  • Vascular Injury
  • Septic Patient
  • Drainage Tube
  • Blunt Dissection