A Case of Descending Necrotizing Mediastinitis in a Previously Healthy Child

Descending necrotizing mediastinitis (DNM) is a rare complication of oropharyngeal and cervical infection, especially in children. We report a case of DNM secondary to a cervical abscess in a previously healthy 1-year-old boy. The patient presented with redness and swelling of the neck and fever. He was treated with an antimicrobial agent for the diagnosis of cervical lymphadenitis. On the sixth day, a huge mediastinal abscess was found, and he was admitted to the intensive care unit. He was successfully treated with surgical drainage and appropriate antimicrobial therapy. The pus culture isolated multiple bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Although we did not use an antimicrobial agent covering MRSA, the symptoms and test results improved. Washing with drainage was effective. The patient required multidisciplinary treatment, and we collaborated with specialists in other departments. DNM is a severe disease in which team medical care is needed to provide appropriate treatment.

The Impact of the COVID-19 Outbreak on Intensive Care in Northern Saitama Japan

Background We examined and compared the actual impact of COVID-19 on local medical care in northern Saitama Japan, especially in intensive care units (ICUs), before (2019) and during (2020) the pandemic. Methods The impact of COVID-19 on emergency care responses was compared with acceptances and refusals in 2019 and 2020. We also examined the number of surgeries performed by ICU surgical departments. The impact on intensive care was examined regarding the numbers of incident reports and the severity percentage calculated from the integrated team medical care and safety system. We also compared the overtime work of physicians working. Results In 2019, there were 2,136 emergency patient requests, and 1,811 patients were received. In contrast, in 2020, there were 2,371 emergency patient requests, and 1,822 patients were accepted, representing a decrease of 76% (p = 0‧931). There were significantly more refusals in 2020, 303 (14‧1%) in 2019 and 506 (21‧3%) in 2020 (p = 0‧0004). In 2020, the number of surgeries increased in neurosurgery, cardiac surgeries, and vascular surgeries and over time increased in all surgical units. There were 396 incidents reported in ICUs in 2019; this increased significantly to 510 in 2020 (p = 0‧001). Conclusion Even though intensive care management was restricted, the number of patients and doctors’ overtime work increased compared to before the spread of COVID-19, and the surrounding environment led to an increase in the number of incidents. The environments in ICUs must be actively improved to prepare for an even more severe situation in the future.