PT  - JOURNAL ARTICLE
AU  - M J Corsten
AU  - F M Shamji
AU  - P F Odell
AU  - J A Frederico
AU  - G G Laframboise
AU  - K R Reid
AU  - E Vallieres
AU  - F Matzinger
TI  - Optimal treatment of descending necrotising mediastinitis.
AID  - 10.1136/thx.52.8.702
DP  - 1997 Aug 01
TA  - Thorax
PG  - 702--708
VI  - 52
IP  - 8
4099  - http://thorax.bmj.com/content/52/8/702.short
4100  - http://thorax.bmj.com/content/52/8/702.full
SO  - Thorax1997 Aug 01; 52
AB  - BACKGROUND: Descending necrotising mediastinitis is caused by downward spread of neck infection and has a high fatality rate of 31%. The seriousness of this infection is caused by the absence of barriers in the contiguous fascial planes of neck and mediastinum. METHODS: The recent successful treatment of seven adult patients with descending necrotising mediastinitis emphasises the importance of optimal early drainage of both neck and mediastinum and prolonged antibiotic therapy. The case is also presented of a child with descending necrotising mediastinitis, demonstrating the rapidity with which the infection can develop and lead to death. Twenty four case reports and 12 series of adult patients with descending necrotising mediastinitis published since 1970 were reviewed with meta-analysis. In each case of confirmed descending necrotising mediastinitis the method of surgical drainage (cervical, mediastinal, or none) and the survival outcome (discharge home or death) were noted. The chi 2 test of statistical significance was used to detect a difference between cases treated with cervical drainage alone and cases where mediastinal drainage was added. RESULTS: Cervical drainage alone was often insufficient to control the infection with a fatality rate of 47% compared with 19% when mediastinal drainage was added (p < 0.05). CONCLUSIONS: Early combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease.