Article

lock Open Access lock Peer-Reviewed

6

Views

ARTIGO ORIGINAL

Mediastinite em cirurgia cardíaca: análise dos fatores de risco e avaliação do tratamento utilizando irrigação contínua com solução de PVPI a 1%

Luiz Cláudio Moreira LimaI; Fernando Antônio Roquete Reis FilhoI; Leonardo A GonçalvesI; Maurício C GomesI; Luciana CasséteI; Raul Corrêa RabeloI; Rodrigo de Castro BernardesI

DOI: 10.1590/S0102-76381996000300008

RESUMO

Com o objetivo de avaliar a eficácia do tratamento da mediastinite com irrigação contínua com solução de polivinilpirrolidona-iodo (PVPI) a 1 %, associada a antibioticoterapia e analisar os fatores de risco desta grave infecção, foram estudados, retrospectivamente, 1113 pacientes submetidos a cirurgia para correção de lesões cardíacas, entre janeiro de 1993 e abril de 1995, no Instituto do Coração do Hospital Madre Teresa, Belo Horizonte, Minas Gerais. Onze fatores de risco para mediastinite foram analisados (idade, sexo, peso, diabetes, hipertensão arterial sistêmica, tabagismo, transfusão sangüínea, tempo de circulação extracorpórea, utilização de enxerto de artéria torácica interna, drenagem pleural e tempo de internação preoperatorio). A análise estatística demonstrou serem fatores de risco: peso (p=0,0001), utilização de enxerto de artéria torácica interna (p=0,001), drenagem de pleura (p=0,001) e tempo de internação pré-operatório (p=0,01). Dezoito (1,6%) pacientes desenvolveram mediastinite no pós-operatório e foram submetidos a tratamento por aesbridamento cirúrgico, ressutura de esterno e instalação de irrigação contínua com solução de PVPI a 1 %, por um período médio de 8 dias. A média de internação hospitalar foi de 37 dias neste grupo de pacientes. O germe predominante foi o S. Aureus (72%). A mortalidade foi de 27% (5 pacientes), devido a infecção fora de controle. Os autores consideram que a facilidade de emprego e manejo da irrigação contínua com solução de PVPI a 1 %, associada a baixa taxa de mortalidade, demonstrou ser um método eficaz no tratamento desta grave complicação pós-operatória.

ABSTRACT

In order to evaluate the efficacy of mediastinitis treatment with continuous wound irrigation with PVP11 % solution, plus antibyotics and surgical treatment, and to analise the risk factors of this serious infection, we retrospectively studied 1113 patients submited to cardiac surgery, between. January 1993 and April 1995, at the Instituto do Coração do Hospital Madre Tereza, Minas Gerais, Brasil. Eleven risk factors to mediastinitis were analized: age, sex, weight, diabetes, hypertension, smoking, blood transfusion, lenght of cardiopulmonary bypass (CPB), use of internal thoracic artery graft, pleural drainaige and hospital stay prior to surgery. Eighteen (1.68%) patients developed mediastinitis in the postoperative period and were treated with surgical intervention, continuous irrigation with PVP 11 % solution and antibyotics, during an average of 8 days. The hospital stay for this group of patients was in average 37 days. The predominant microorganism found was S. aureus (72%). The mortality was 27% (5 patients) due to disseminated infection. The authors conclude that continuous wound irrigation with PVP 11 % solution was an ease procedure with low mortality rate. The present method is effective in the treatment of this serious post-operative complication.
Texto completo disponível apenas em PDF.

REFERÊNCIAS

1. Sarr M G, Gott V L, Townsend T R - Mediastinal infection after cardiac surgery (collective review). Ann Thorac Surg 1984; 38: 415-23. [MedLine]

2. Barois A, Grosbuis S, Simon N et al. - Treatment of mediastinitis in children after cardiac surgery: a study of 20 cases, intensive Care Med 1978; 4: 35-9. [MedLine]

3. Bruniaux J, Gibert G, Witchitz J et al. - Médiastinitis aigues suppurées avec hémocultures positives dans la suite de la chirurgie cardiovasculaire. Ann Chir Thorac Cardiovasc 1974; 13: 25-9.

4. Heath B J & Bagnato V J - Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage. J Thorac Cardiovasc Surg 1987; 94: 355-60. [MedLine]

5. Ohmi M, Sato K et al. - Continuous irrigation followed by combined omental transposition and pectoral muscle rotation for treatment of postoperative mediastinitis with DIC in a child. Nippon Kyobu Geka 1993; 41: 678-81.

6. Scully H E, Martin R D, Leclerc Y et al. - Comparison between antibiotic irrigation and mobilization of pectoral muscle flaps in treatment of deep sternal infection. J Thorac Cardiovasc Surg 1985; 90: 523-31. [MedLine]

7. Trouillet J L, Chastre J, Fagon J Y et al. - Use of granulated sugar in the treatment of open mediastinitis after cardiac surgery. Lancet 1985; 2: 180-4. [MedLine]

8. Verkkala K & Jarvinen A - Mediastinal infection following open heart surgery: treatment with retrosternal irrigation. Scand J Thorac Cardiovasc Surg 1986; 20: 203-7. [MedLine]

9. Thurer R J, Bognolo D, Vargas A et al. - The management of the mediastinal infection following cardiac surgery: an experience utilizing continuous irrigation with povidone-iodine. J Thorac Cardiovasc Surg 1974; 68: 962-8. [MedLine]

10. Breyer R H, Mills S A, Hudspeth A S et al. - A prospective study of sternal wound complications. Ann Thorac Surg 1984; 37: 412-6. [MedLine]

11. Cheung R H, Craver J M, Jones E L et al. - Mediastinites after cardiac valve operations: impact upon survival. J Thorac Cardiovasc Surg 1985; 90: 517-22. [MedLine]

12. Grossi E A, Culliford A T, Krieger K H et al. - A survey of seventy-seven major infectious complications of median sternotomy: a review of 7949 consecutive operative procedures. J Thorac Cardiovasc Surg 1985; 40: 214-23.

13. Bor D H, Rose R M, Modlin J F, Weintraub R, Friedland G H - Mediastinitis after cardiovascular surgery. Rev Infect Dis 1983; 5: 885-97. [MedLine]

14. Culliford A T, Cunningham J N, Zeff R H, Isom O W, Teiko P, Spencer F C - Sternal and costocondral infections following open-heart surgery: a review of 2594 cases. J Thorac Cardiovasc Surg 1976; 72: 714-25.

15. Ottino G, Paulis R D, Pansini S et al. - Major sternal wound infection after open heart surgery: a multivariate analysis of risk factors in 2579 consecutive operative procedures. Ann Thorac Surg 1987; 44: 173-8.

16. Newman L S, Szezukowski L C, Bain R P, Perlino C A - Suppurative mediastinitis after open-heart surgery: a case control study of risk factors. Chest 1988; 94: 546-53. [MedLine]

CCBY All scientific articles published at bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2022 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY