Evolução clínica de pacientes com mediastinite pós-cirurgia de revascularização miocárdica submetidos à oxigenoterapia hiperbárica como terapia adjuvante Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery

ABSTRACT Objective : To evaluate the use of hyperbaric oxygen therapy as an adjunctive treatment in mediastinitis after coronary artery bypass surgery. Methods: This is a retrospective descriptive study, performed between October 2010 and February 2012. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite antibiotic therapy. Results: We identified 18 patients with mediastinitis during the study period. Thirty three microorganisms were isolated, and polymicrobial infection was present in 11 cases. Enterobacteriaceae were the most prevalent pathogens and six were multi-resistant agents. There was only 1 hospital death, 7 months after the oxygen therapy caused by sepsis, unrelated to hyperbaric oxygen therapy. This treatment was well-tolerated. Conclusion: The initial data showed favorable clinical outcomes. Keywords: Hyperbaric oxygenation; Mediastinitis/therapy; Myocardial revascularization; Osteomyelitis; Surgical wound infection/therapy INTRODUCAO A infeccao de ferida operatoria profunda e uma grave complicacao da cirurgia de revascularizacao do miocar-dio (CRM), sendo responsavel por altas taxas de mor-bidade e mortalidade, com consequente aumento dos custos medico-hospitalares e internacoes prolongadas. Sua incidencia pode variar entre 0,4% a 5,3% e sua mortalidade, no periodo intra-hospitalar, de 10 a 47%. Em nossa instituicao, a incidencia de mediastinite e de 0,5%, com mortalidade de 8,4%