Overview

Mediastinitis is a potentially life-threatening disease that causes a lifelong impact on the patient’s life. This article aims to investigate the negative effect of mediastinitis on patients' quality of life. We will explore the lifestyle changes of patients with different variants of mediastinitis in addition to comparing their living standards during infection and post-recovery. 

The negative quality of life that the patients suffer from mainly stems from the symptoms of the disease. Symptoms of mediastinitis include:¹

• Blocked airway
• Severe chest pain
• Respiratory distress, including shortness of breath
• Sepsis
• Severe bleeding 
• Loss of stamina
• Pneumonia
• Fever 
• Dysphagia 

Potential effects on patients’ quality of life

If discovered late, mediastinitis could even be life-threatening, causing psychological, physical, financial and social distress to the patients and their families. 

Mediastinitis could be a chronic disease in some patients, as the chronic form of it develops slowly over several months to years and has a late mortality rate(death occurs after more than 5 years of diagnosis)²

This causes long-term reduced standards in quality of life as the symptoms persist, causing prolonged hospitalization, repeated surgical interventions, and a prolonged recovery period. Patients may lose their source of income as they are physically unable to work and suffer financially.  Meanwhile, the alternative form of mediastinitis, acute mediastinitis, is associated with post-surgery complications³ and could develop within a month or even as short as a few hours. Both forms of mediastinitis affect patients’ quality of life socially, physically and mentally.

Introduction

What is mediastinitis and what are the causes of it?

Mediastinitis is an infection that causes the inflammation of the mediastinum in the mid-chest area.⁴ There are two main types of mediastinitis- acute and chronic. Acute mediastinitis is associated with critical and rapid progression, while chronic mediastinitis is associated with slow development.⁵ The two variants have different causes and treatment processes. Mediastinitis can be caused by many causes, but mainly by a tear in the oesophagus (Esophageal perforation), complications from chest surgeries like coronary artery bypass graft procedure, or Infection that spreads from the head or neck (descending necrotizing mediastinitis).³

What are the causes and the risk factors of mediastinitis?

Causes of mediastinitis 

• Tracheal or esophageal rupture⁶ 
• Direct traumatic injury 
• Spread of pulmonary infection
• Pancreatitis
• Chest surgery or upper GI endoscopy⁷
• Diabetes mellitus⁸ 
• Fungal infection (Histoplasmosis) 
• COPD(Chronic Obstructive Pulmonary Disease)

Patients with obesity, prior heart surgery and NYHA CHF class III or IV are 20 times more likely to be infected with mediastinitis.⁹

Impact of mediastinitis on quality of life

Impacts on physical health include symptoms mentioned: Blocked airway, severe chest pain, respiratory distress, sepsis, severe bleeding, loss of stamina, pneumonia, fever, dysphagia. All these symptoms make the day-to-day life of mediastinitis patients difficult. Difficulty in breathing and loss of stamina for these patients may limit the amount of physical activities that patients can participate in. Patients may no longer take part in sports or other active activities. Severe bleeding, pneumonia and chest pain bring a lot of physical pain to the patients, which prevents them from performing day-to-day tasks.

Sepsis causes patients’ bodies to respond to infections improperly. Sepsis is a condition known to affect people's lives negatively. Sepsis can be life-threatening and is one of the reasons that mediastinitis can be deadly. Sepsis can cause organ dysfunction, providing great pain to patients. Many survivors of sepsis have cognitive impairment, physical disability, and sensory and emotional problems. Some patients also suffer mentally as they recall ICU events and gain unpleasant memories.¹⁰ This causes them to struggle to rejoin the workforce and enjoy physical activities, preventing patients from regaining a normal life after recovery.¹¹ This hugely affects the quality of life of mediastinitis patients negatively, even post-recovery. It is reported that the survivors of sepsis have a lower quality of life and are less likely to return to the workforce or perform daily activities after recovery.¹⁰

Dysphagia causes the patient to have difficulty swallowing. This may prevent patients from consuming food normally. Study shows that dysphagia hugely impacts patients’ quality of life. Patients would require additional time to eat, cough when eating or drinking, constantly have a dry mouth, be required to drink when swallowing foods and swallow a few times to ingest food.¹²

 This disability causes inconvenience in the day-to-day living of patients, hugely affecting their quality of life. Many patients also reportedly feel embarrassed while eating with others, showing that this disease can affect patients on a social level. Many also reported that they can no longer enjoy eating the same way they did and feel handicapped. Patients may have lower self-esteem and overall happiness in life.

If discovered late, Acute mediastinitis, like postsurgical and descending necrotizing mediastinitis, is associated with high long-term mortality. Particularly, descending necrotizing mediastinitis has a higher mortality of  20% to 40%.¹³

This is also apparent in acute mediastinitis due to coronary artery bypass graft surgery.¹⁴ Although it is a low-risk complication, it has a high risk of early morbidity and reduced long-term survival due to cardiac deaths. The mortality of these patients has a significant increase during the first year, followed by a threefold increase during their 4-year follow-up period.¹⁵ This long period of uncertainty provides a large amount of mental trauma and distress to mediastinitis patients, as it presents uncertainty in the survival of patients.

Prevention of mediastinitis^16,3

• Reduce smoking before heart surgery 
• Obese patients are encouraged to lose weight before surgery 
• Optimise preoperative glycaemic control in diabetic patients with high HbA1c levels
• Ensure a sterile environment pre-surgery 
• Health check-ups
• Have good oral hygiene 
• Visit a dentist every 6 months

Quality of life of mediastinitis patients post-treatment

According to a study that interviewed 12 descending necrotizing mediastinitis,¹⁷ patients claimed that their quality of life was not damaged permanently. However, a small number of patients still claim that they struggle to swallow when eating, cough when they eat and experience pain when eating. This study shows that patients who recovered from mediastinitis have a relatively full recovery in general. Mediastinitis patients mustn't lose hope in seeking recovery. 

Strategies to improve quality of life

Early diagnosis of mediastinitis is key to recovery. Mediastinitis is diagnosed through symptoms, past medical history, recent surgeries and travel history. A CT scan (Contrast-enhanced computed tomography scan) is used for diagnosis. A chest X-ray may also be used. If mediastinitis is identified and treatment is received within 24 hours after a tear, there is death rate of less than 10%. However, that number increases to 30-40% if the treatment is received 24 hours or more.¹³

It is therefore important to consult a medical professional if you suspect mediastinitis. If you are diagnosed with descending necrotizing mediastinitis, it is necessary to have follow-up check-ups. Treatment usually includes broad-spectrum antibiotics after surgery, after a CT scan. It is important to take antibiotics according to the doctor’s direction to prevent antibiotic resistance and to completely remove the infection.¹³

Real-life example of a mediastinitis patient¹⁸

The success story of Cody Fry from Iowa, who suffered from fibrosing mediastinitis, is a prime example of how mediastinitis could be managed. His experience also highlighted how important a positive attitude and a medical team are in improving his quality of life. 

Cody faced a quality-of-life impact in his journey. He had to drop out of college due to the disease and had physical limitations that prevented him from walking long distances. He also had a worse social life and emotional well-being as his life revolved around hospital visits and medical procedures. His case shows that mediastinitis has a huge negative impact on one’s future and career path.

Although in his case, his mediastinitis cannot be cured, the medical team at the  University of Iowa Hospitals & Clinics used different techniques to improve his life. Techniques like using tiny catheters to block leaks in his bronchial vessels when he is coughing up blood and placing stents in his veins to improve blood flow and reduce pressure buildup are used. If diagnosed with the disease, it is important to believe in your medical team and have patience in the journey to recovery. 

It is also important to have a good supportive system. Educating patients and their families about the disease and its potential complications is vital as this can equip them with skills to face the disease. Through effective management of symptoms and supportive care, patients like Cody can live a more fulfilling life despite being infected with the disease.

Summary

Mediastinitis is a potentially life-threatening condition with significant long-term impacts on patients' quality of life. The illness can cause physical, psychological, financial, and social distress, often leading to prolonged hospitalizations, repeated surgeries, and an inability to work. As early diagnosis is key to a lower mortality rate, it is important to consult a medical professional as soon as possible to minimise its damage to health. It is also important to follow the doctor's direction after the diagnosis to ensure a quick recovery. This can ensure a better quality of life when infected and post-recovery.