Hung Yu-Cheng, Ho Chia-Ying, Chan Kai-Chieh, Wang Yu-Chien, Chin Shy-Chyi, Chen Shih-Lung
School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Ear Nose Throat J. 2024 Sep 12:1455613241272479. doi: 10.1177/01455613241272479.
Deep neck infection (DNI) involves the deep neck spaces and may lead to airway compromise. An intensive care unit (ICU) is a specialized unit of the hospital that provides intensive care. ICU care is required for patients with severe DNI, although the risk factors for need of ICU care in patients with DNI have not been investigated. The clinical and laboratory parameters of 350 patients aged >18 years who were diagnosed with DNI between October 2018 and October 2023 were evaluated. Of these patients, 62 were transferred to the ICU. Univariate and multivariate analyses were applied to assess the risk factors for need of ICU care. Univariate analysis revealed that older age [odds ratio (OR) = 1.0324, 95% confidence interval (CI): 1.0155-1.0496, = .0001], a higher C-reactive protein (CRP) level (OR = 1.0076, 95% CI: 1.0049-1.0103, < .0001), and blood glucose level (OR = 1.0057, 95% CI: 1.0023-1.0091, = .0011), involvement ≥3 spaces (OR = 2.2366, 95% CI: 1.2827-3.8998, = .0046), and mediastinitis (OR = 4.7134, 95% CI: 2.3537-9.4391, < .0001) were significant risk factors for ICU transfer in patients with DNI. In multivariate analysis, older age (OR = 1.0216, 95% CI: 1.0032-1.0403, = .0210), higher CRP level (OR = 1.0063, 95% CI: 1.0033-1.0092, < .0001), and mediastinitis (OR = 2.6103, 95% CI: 1.1974-5.6905, = .0158) were independent risk factors of ICU transfer in patients with DNI. The ICU group had a longer hospital stay (23.98 ± 8.53 vs 7.44 ± 4.24, < .0001) and higher rate of tracheostomy ( < .0001) than the non-ICU group. However, there were no significant differences in the rate of incision and drainage open surgery or pathogens between the groups (all > .05). Elder patients and those with advanced CRP levels and mediastinitis are more likely to be transferred to the ICU, leading to prolonged hospital stays and a higher risk of tracheostomy. Clinicians should assess the patient's need for ICU transfer and timely manage the airway according to the aforementioned laboratory parameters and complications carefully.
颈部深部感染（DNI）累及颈部深部间隙，可能导致气道受压。重症监护病房（ICU）是医院提供重症监护的专门科室。重症DNI患者需要ICU护理，尽管DNI患者需要ICU护理的危险因素尚未得到研究。对2018年10月至2023年10月期间诊断为DNI的350例年龄>18岁患者的临床和实验室参数进行了评估。这些患者中，62例被转入ICU。采用单因素和多因素分析来评估需要ICU护理的危险因素。单因素分析显示，年龄较大[比值比（OR）=1.0324，95%置信区间（CI）：1.0155 - 1.0496，P = .0001]、C反应蛋白（CRP）水平较高（OR = 1.0076，95%CI：1.0049 - 1.0103，P < .0001）、血糖水平（OR = 1.0057，95%CI：1.0023 - 1.0091，P = .0011）、累及≥3个间隙（OR = 2.2366，95%CI：1.2827 - 3.8998，P = .0046）和纵隔炎（OR = 4.7134，95%CI：2.3537 - 9.4391，P < .0001）是DNI患者转入ICU的显著危险因素。多因素分析显示，年龄较大（OR = 1.0216，95%CI：1.0032 - 1.0403，P = .0210）、CRP水平较高（OR = 1.0063，95%CI：1.0033 - 1.0092，P < .0001）和纵隔炎（OR = 2.6103，95%CI：1.1974 - 5.6905，P = .0158）是DNI患者转入ICU的独立危险因素。ICU组的住院时间长于非ICU组（23.98±8.53 vs 7.44±4.24，P < .0001），气管切开率也高于非ICU组（P < .0001）。然而，两组之间切开引流开放手术率或病原体方面无显著差异（均P > .05）。老年患者以及CRP水平较高和患有纵隔炎的患者更有可能被转入ICU，导致住院时间延长和气管切开风险增加。临床医生应根据上述实验室参数和并发症仔细评估患者转入ICU的必要性，并及时管理气道。
