Technique of right single-lung transplantation for idiopathic pulmonary fibrosis using cross-field ventilation

airway management. Corsten and associates’ 4 meta-analysis demonstrated a signif icant survival advantage in those patients who were treated by a combined drainage of the neck and mediastinum versus cervical drainage alone. The authors recommend a formal thoracotomy to drain the chest. Brunelli and colleagues, 5 however, recommend a cervicomediastinal drainage (cervical incision to enter the thorax) of the mediastinum for cases of superior mediastinitis, with a formal thoracotomy reserved for those cases in which the DNM involvement extends beyond the carina. Our surgical approach through a median sternotomy associated with a transverse cervical incision was based on the fact that the patient had a compromised cardiac output and CT findings consistent with a predominant anterior and middle mediastinitis. The posterior and infracarinal mediastinum were less affected by the disease. Our purpose was to decompress the heart along with a proper debridement. Inotropic requirements after surgery were significantly lower. Abscesses tend to reform in the days after surgery, and a daily cervical wash is necessary to release collections and to collapse forming abscesses. Irrigation and drainage of the mediastinum are conducted daily. Management of DNM should always be surgical, with broad, extensive, open cervicotomy together with ample mediastinal drainage and associated thoracotomy, if necessary, to ensure the adequate drainage of all mediastinal compartments.