Ramos-Hinojosa Zaid I, Álvarez-Maldonado Pablo, Hernández-Ríos Grisel, Hernández-Solís Alejandro, Reding-Bernal Arturo, Andrade-Chávez Rubén, Navarro-Reynoso Francisco
Pulmonology and Thoracic Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmis 148, Colonia Doctores, 06726, Mexico City, Mexico.
Research Division, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.
Eur Arch Otorhinolaryngol. 2025 May;282(5):2617-2625. doi: 10.1007/s00405-024-09179-7. Epub 2024 Dec 23.
To describe the clinical features and identify mortality risk factors in descending necrotizing mediastinitis (DNM) complicating deep neck abscesses (DNA) among patients admitted to the ICU.
A retrospective analysis was conducted on consecutive patients admitted to the ICU of a tertiary care public hospital. Data were collected from July 2017 to July 2024. A bivariate analysis of variables, along with a multiple logistic regression model, were performed to identify mortality risk factors.
Forty-five patients with DNA complicated by DNM were admitted to the ICU, of whom 29 (58%) were men. The mean age was 49.8 ± 14 years. All underwent emergency neck and mediastinum debridement. Forty-one (91%) were admitted directly from the operating room. All DNAs were of odontogenic origin. In 36 patients (80%), the mediastinal infection extended below the tracheal carina. Thirty-nine patients (86.6%) required mechanical ventilation, and 25 (55.5%) presented with septic shock. The in-hospital mortality rate was 33.3%. Risk factors for mortality in the bivariate analysis included the total SOFA (Sequential Organ Failure Assessment) score, individual SOFA components (respiratory, hematologic, and cardiovascular), SAPS-3 (Simplified Acute Physiology Score-3), platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio. In the multivariate analysis, the number of neck surgical debridements performed during ICU stay and the SOFA respiratory component were independent predictors of mortality.
DNM complicating a DNA is a severe condition frequently associated with septic shock and multi-organ failure. Impaired oxygenation at admission and the number of neck wound debridements significantly influenced patient outcomes.
描述重症监护病房（ICU）收治的合并下行性坏死性纵隔炎（DNM）的深部颈部脓肿（DNA）患者的临床特征，并确定死亡风险因素。
对一家三级护理公立医院ICU收治的连续患者进行回顾性分析。收集2017年7月至2024年7月的数据。对变量进行双变量分析，并建立多元逻辑回归模型以确定死亡风险因素。
45例合并DNM的DNA患者入住ICU，其中29例（58%）为男性。平均年龄为49.8±14岁。所有患者均接受了紧急颈部和纵隔清创术。41例（91%）直接从手术室收治。所有DNA均源于牙源性。36例患者（80%）纵隔感染蔓延至气管隆突以下。39例患者（86.6%）需要机械通气，25例（55.5%）出现感染性休克。住院死亡率为33.3%。双变量分析中的死亡风险因素包括总序贯器官衰竭评估（SOFA）评分、SOFA各单项评分（呼吸、血液学和心血管）、简化急性生理学评分-3（SAPS-3）、血小板与淋巴细胞比值以及单核细胞与淋巴细胞比值。多变量分析显示，ICU住院期间颈部手术清创次数和SOFA呼吸单项评分是死亡的独立预测因素。
合并DNM的DNA是一种严重疾病，常与感染性休克和多器官功能衰竭相关。入院时的氧合受损情况和颈部伤口清创次数对患者预后有显著影响。
