Chest packing with negative pressure generating chest tube for intractable mediastinal bleeding after cardiac surgery

Abstract

Abstract Background Postoperative mediastinal bleeding is one of the most frequently reported complications of cardiac surgeries, which can be life-threatening. This study aimed to evaluate the feasibility of open chest and delayed sternal closure using a simple modified negative pressure packing technique for management of intractable bleeding after sternotomy. Methods Twenty patients who had undergone chest packing primarily for intractable bleeding after cardiac/thoracic aorta surgery via sternotomy at our hospital between January 2010 and August 2022 formed our study population. Their medical records were reviewed retrospectively. Patients who required an open chest for hemodynamic compromise were excluded. Gauzes were packed around the bleeding area and additional gauze was used to mask the structures. A 32-Fr. regular chest tube was placed on top of the covered gauze while the side holes were covered using additional gauze. The open wound was sealed with an adhesive drape film. The chest tubes were connected to a regular bottle with a negative pressure of 20 mmHg to collapse gauzes. Results Nineteen (95%) patients with the median age of 57.0 years underwent aorta-related surgery during the study period. The chest was closed within 2 days after open sternum in 18 patients (90%). One patient (5%) needed emergent chest wash-out for cardiac tamponade due to an ongoing hematoma during open chest. One patient (5%) newly developed mediastinitis and sepsis but was discharged without any other complications after intravenous antibiotics treatment. Two (10%) hospital mortalities occurred. One patient died of septic shock while the other due to intracranial hemorrhage. Conclusion Temporary open sternum and delayed chest closure using negative pressured gauze packing is a simple, safe, and effective lifesaving technique that can be used in patients with intractable mediastinal bleeding after cardiac surgery.