Descending necrotizing mediastinitis

Abstract

Descending necrotizing mediastinitis (DNM) is one of the most dreadful infections in medicine, originated from a superior site above the thoracic cavity that eventually extends through the cervical spaces and fascia into one of the pathways of descent, opening its way into the mediastinum causing an overwhelming septic process that left untouched, could cause the patient's death. There are now strict diagnostic criteria that the physician needs to search for when treating this rare group of patients to achieve the best possible outcome. The chapter will discuss how these present to the ER and what are the adequate processes that have to be set in motion to save their lives. All the information presented will be correlated to the best up to date available evidence and the authors' institutional results where the largest series of patients has been published. It is of the utmost importance that this disease is identified in a timely fashion so that emergent surgical drainage and lavage of the mediastinal spaces are performed, followed with resuscitation at an Intensive Respiratory Care Unit, being vigilant of the patient's metabolic immunologic response and a watchful eye to possible post-operative complications that may arise so they could be treated in the earliest manner.