CURACIONES INDICADAS EN EL TRATAMIENTO DE MEDIASTINITIS LUEGO DE UNA CIRUGÍA CARDÍACA: REVISIÓN INTEGRADORA

Frantz, Cristina Valéria; Stocco, Janislei Giseli Dorociaki; Ribeiro, Anna Carolina Gaspar; Vieira, Ana Laura Gomide

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Literature Review • Texto contexto - enferm. 28 • 2019 • https://doi.org/10.1590/1980-265X-TCE-2018-0073 copiar

CURACIONES INDICADAS EN EL TRATAMIENTO DE MEDIASTINITIS LUEGO DE UNA CIRUGÍA CARDÍACA: REVISIÓN INTEGRADORA

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

identificar y describir cuáles son las curaciones recomendadas en el tratamiento de mediastinitis luego de una cirugía cardíaca en pacientes adultos.

Método:

revisión integradora realizada en las bases de datos MEDLINE/PubMed, LILACS, CINAHL, Web of Science, Cochrane, SCOPUS y búsqueda manual, entre diciembre de 2017 y enero de 2018. Se seleccionaron estudios sobre curaciones utilizadas en el tratamiento de la mediastinitis luego de una cirugía cardíaca.

Resultados:

se incluyen ocho artículos: tres abordaron la terapia de heridas por presión negativa e indican que gran parte de los pacientes analizados obtuvo éxito en el tratamiento, disminuyendo así la necesidad de otras intervenciones; cuatro compararon la terapia anterior con curaciones convencionales, en que se llegó a la conclusión de que las tasas de reinfección esternal y de mortalidad hospitalaria eran menores en el primer grupo; y uno comparó la terapia asistida por vacío con sistema de drenaje cerrado, donde se pudo comprobar las tasas inferiores de reinfección esternal en el grupo, bajo tratamiento por vacío.

Conclusión:

las evidencias indican que el uso de terapia por vacío para el tratamiento de mediastinitis, luego de la cirugía cardíaca, fue efectiva. Sin embargo, a pesar del desenlace positivo, se sugieren realizar ensayos clínicos con una rigurosa descripción metodológica y muestras significativas para minimizar el riesgo de reincidencia y evaluar el impacto de las curaciones en el tratamiento de la mediastinitis.

DESCRIPTORES
Enfermería; Mediastinitis; Cirugía torácica; Revisión; Tratamiento

ID*	Title	Country/ Year	Designing	Intervention	Outcomes
A11010. Elawadi MA, Oueida F. Vacuum-assisted closure system in treatment of postoperative mediastinitis. Asian Cardiovasc Thorac Ann. 2013 Dec;21(6):708-12. Errata in: Asian Cardiovasc Thorac Ann. 2014 Oct 10;23(1):117.	Vacuum-assisted closure system in treatment of postoperative mediastinitis	Saudi Arabia, 2013	Retrospective observational	Vacuum Assisted Therapy (AntiV.A.C.)	Wound closure: 21 patients (61.76%) had a direct surgical wound closure and 13 (41.16%) required a new fixation.
A21111. Vos RJ, Yilmaz A, Sonker U, Kelder JC, Kloppenburg GTL. Vacuum-assisted closure of post-sternotomy mediastinitis as compared to open packing. Interact Cardiovasc Thorac Surg [Internet]. 2011 Nov [cited 2017 Oct 17];14(1):17-21. Available from: Available from: https://academic.oup.com/icvts/article/14/1/17/687706 https://academic.oup.com/icvts/article/1...	Vacuum-assisted closure of post-sternotomy mediastinitis as compared to open packing	Netherlands, 2012	Retrospective observational	Vacuum Assisted Therapy (-75 to -125 mmHg) versus conventional dressings	Wound closure: Of the 89 patients undergoing vacuum therapy, 62 (69.66%) required new sternal fixation, and in 27 (30.33%) the wounds were closed for second intention. Mortality: In-hospital mortality was lower in the vacuum treated group (12.4% p =0.0032).
A31212. Chen Y, Almeida AA, Mitnovetski S, Goldstein J, Lowe C, Smith JA. Managing deep sternal wound infections with vacuum-assisted closure. ANZ J Surg [Internet]. 2008 May [cited 2017 Oct 17];78(5):333-6. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1445-2197.2008.04467.x/abstract http://onlinelibrary.wiley.com/doi/10.11...	Managing deep sternal wound infections with Vacuum-assisted closure	Australia, 2008	Retrospective observational	Vacuum Assisted Therapy (-125 mmHg) versus Vacuum Assisted Therapy with Sternal Reconstruction	Mortality: Of the 17 (65.38%) patients who only used vacuum therapy, six (35.29%) died due to infection. Sternal reconstruction: the remaining nine patients (34.61%) required sternal reconstruction.
A41313. Petzina R, Hoffmann J, Navasardyan A, Malmsjö M, Stamm C, Unbehaun A, et al. Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sternal re-infection rate compared to conventional treatment. Eur J Cardiothorac Surg [Internet]. 2010 July [cited 2017 Oct 17];38(1):110-3. Available from: Available from: https://academic.oup.com/ejcts/article/38/1/110/469114 https://academic.oup.com/ejcts/article/3...	Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sternal re-infection rate compared to conventional treatment	Germany, 2010	Retrospective observational	Negative Pressure Wound Therapy set at -125 mmHg versus conventional treatment	Reinfection: two patients in the Negative Pressure Wound Therapy group compared to nine patients in the conventional group (p=0.008). Mortality: Negative Pressure Wound Therapy reduced the mortality rate (p=0.005) and tended to decrease the duration of hospitalization (p=0.08).
A51414. Pericleous A, Dimitrakakis G, Photiades R, von Oppell UO. Assessment of vacuum-assisted closure therapy on the wound healing process in cardiac surgery. Int Wound J [Internet]. 2016 Dec [cited 2017 Oct 17];13(6):1142-9. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/iwj.12430/abstract. http://onlinelibrary.wiley.com/doi/10.11...	Assessment of Vacuum-assisted closure therapy on the wound healing process in cardiac surgery	United Kingdom, 2015	Retrospective observational	Vacuum Assisted Therapy (-125 mmHg)	Reintervention: of the 52 patients, 88.5% (n=46) treated exclusively with vacuum therapy were successful, and six (11.5%) required plastic interventions. Mortality: no death related to complications of vacuum therapy.
A61515. Risnes I, Abdelnoor M, Veel T, Svennevig JL, Lundblad R, Rynning SE. Mediastinitis after coronary artery bypass grafting: the effect of vacuum-assisted closure versus traditional closed drainage on survival and re-infection rate. Int Wound J [Internet]. 2014 Apr [cited 2017 Oct 17];11(2):177-82. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X.2012.01060.x/abstract http://onlinelibrary.wiley.com/doi/10.11...	Mediastinitis after coronary artery bypass grafting: the effect of Vacuum-assisted closure versus traditional closed drainage on survival and re-infection rate	Norway, 2012	Retrospective Cohort	Vacuum Assisted Therapy (-125 mmHg) versus conventional drainage	Reintervention: of the 66 patients treated with conventional drainage therapy, ten (15.1%) required a muscle graft to close the wound, and in the vacuum group, nine (14.1%) required a graft. Mortality: there was no significant difference in the mortality rate after 30 days between the two groups.
A71616. Steingrimsson S, Gottfredsson M, Gudmundsdottir I, Sjögren J, Gudbjartsson T. Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections. Interact Cardiovasc Thorac Surg [Internet]. 2012 Sept [cited 2017 Oct 17];15(30):406-10. Available from: Available from: https://academic.oup.com/icvts/article/15/3/406/641933 https://academic.oup.com/icvts/article/1...	Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections	Iceland, 2012	Retrospective Cohort	Negative Pressure Wound Therapy (GranuFoam™) adjusted in -125 mmHg versus conventional dressing (chlorhexidine or paraffin).	Infection: in the conventional group, eight patients required surgical review for reinfections. In the vacuum therapy group, one patient reinfected (p=0.02). six patients in the conventional dressing group developed late chronic sternal infections (p=0.10). Mortality: 30-day mortality was not significantly different between groups one and two (4% vs 0%, p>0.1).
A81717. Deniz H, Gokaslan G, Arslanoglu Y, Ozcaliskan O, Guzel G, Yasim A, et al. Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment. J Cardiothorac Surg [Internet]. 2012 July [cited 2017 Oct 17];7(67):2-7. Available from: Available from: https://dx.doi.org/10.1186/1749-8090-7-67 https://dx.doi.org/10.1186/1749-8090-7-6...	Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment	Turkey, 2012	Retrospective observational	Negative Pressure Wound Therapy (-75 and -125 mmHg) versus conventional treatment.	Reintervention: all patients in the group undergoing NPWT (n=47) required only sternal fixation, and three patients in the conventional treatment group (n=43) required muscle grafting. Mortality: the mortality rate after 90 days was significantly lower in the Negative Pressure Wound Therapy group.

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[1] CORRESPONDENCE AUTHOR
Cristina Valéria Frantz crisvfrantz@hotmail.com