Post-Operative Management in Patients with Permanent Pacemakers Who Underwent Sternotomy e.c. Mediastinitis Complicated from Submandibular Absces in Intensive Care Unit: A Case Report

Background: In the present day, the utilization of cardiac implanted electronic devices is increasing globally due to advancements in medical technology. However, a significant concern arises in the form of serious and life-threatening consequences such as mediastinitis and deep sternal wound infections. Poor control of mediastinitis significantly increases morbidity and mortality rates associated with it. Case presentation: A 44-year-old male presents with a palpable mass on the left jaw that has been present for four days before admission. The patient is currently experiencing symptoms of fever and dyspnea. The patient's medical history from six months ago reveals the insertion of a permanent pacemaker VVIR (dual sensor ventricular demand rate responsive) due to a sinus pause with ventricular escape beat. The patient was admitted to the Intensive Care Unit (ICU) with a diagnosis of post-sternotomy for a submandibular abscess with intra-thoracic extension, respiratory failure, sinus arrest caused by the insertion of the permanent pacemaker, and sepsis. By the third day in the Intensive Care Unit (ICU), the patient's hemodynamic condition had reached a stable state. Conclusion: Upon assessing the patient's reliance on permanent pacemakers (PPM), it is advisable to contemplate the possibility of reprogramming or resetting the implanted PPM. Thorough treatment of critically ill patients is necessary for those who are undergoing surgery with an implanted cardiac device.