[HSF] Post op mediastinitis

[Nasser F. Abou'Seada]

that is a key word
the most horrible cases I have ever seen were all having stress diabetes
.... appeared postoperatively .... non present preoperatively .... and their
mortality is high .... and the huperglycaemia if very difficult to control,
even with insulin infusion .... a high index of suspicion is mandatory .....
vigilant attendance is of utmost important, so is early surgical debridement
... prolonged mediastinal wash seems to have marvelous effects .... IMHO.
..... yet fungal infection at the end is very troublesome .... mostly fatal
... IMHExperience

NFA


On 9/9/07, Tony Furnary <tfurnary at starrwood.com> wrote:
>
> Gee -- does anyone (other than me) think that peri-operative hyperglycemia
> just might have something to do with it?
>
> So, Ahmed, what were the blood glucose levels pre-op and for the first
> three postoperative days in those patients who got infected?
>
>
> -----Original Message-----
> From:   Douville, Chuck [mailto:ecdouville at orclinic.com]
> Sent:   Sat 9/8/2007 9:00 AM
> To:     OpenHeart-L at lists.hsforum.com
> Cc:
> Subject:        RE: [HSF] Post op mediastinitis
>
> This can be a terribly difficult problem to solve. I am aware of a
> hospital where the usual investigations turned up nothing; measures such as
> observers' timing surgeon scrub times at the sink were instituted to no
> avail. Eventually a slow leak from an upstairs toilet was identified to drop
> into the cabinet where some sterile packs were stored in the OR leading to
> naturally, gram negative infections. In our own institution, one infection
> blip led to routine nasal culture of all team members to identify Staph
> carriers and treat them. We now culture pts nares pre-operatively and if
> positive, treat them with mupirocin pre-operatively.
>
> Ahmed my suggestion is, if you think there is a problem, look beyond the
> obvious things we would all think of and encourage your consultants to help
> you do so. Your infection control nurse can sometimes help with this as
> well.
>
> ________________________________
>
> From: openheart-l-bounces at lists.hsforum.com on behalf of psimha
> Sent: Sat 9/8/2007 6:44 AM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Post op mediastinitis
>
>
>
> Gram positive or negative infections ?
> Prasanna
> A wrote:
> > Dear Forum Members:
> >
> > During the past few weeks we had more than our fair share of deep
> > mediastinitis. We are taking all the usual precautions nothing has
> changed
> > but it seems that we are in it for the duration. We consulted ID team
> and
> > the Infection control at the hospital. Does any one of the members have
> more
> > advice for this frustrating problem? I know the issue is boring and not
> > exciting but I would appreciate all inputs. Thank you
> >
> >
> >
> > Ahmed
> >
> >
> >
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