Abstract
Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation. However, no previous study has explored risk factors associated with the need for a tracheostomy in patients with DNI. This article investigates the risk factors for the need for tracheostomy in patients with DNI. Between September 2016 and February 2020, 403 subjects with DNI were enrolled. Clinical findings and critical deep neck spaces associated with a need for tracheostomy in patients with DNI were assessed. In univariate and multivariate analysis, older age (≥65 years old) (OR = 2.450, 95% CI: 1.163–5.161, p = 0.018), multiple spaces involved (≥3 spaces) (OR = 4.490, 95% CI: 2.153–9.360, p = 0.001), and the presence of mediastinitis (OR = 14.800, 95% CI: 5.097–42.972, p < 0.001) were independent risk factors associated with tracheostomy in patients with DNI. Among the 44 patients with DNI that required tracheostomy, ≥50% of patients had involvement of the parapharyngeal or retropharyngeal space (72.72% and 50.00%, respectively). Streptococcus constellatus (25.00%) was the most common pathogen in patients with DNI who required tracheostomy. In conclusion, requiring a tracheostomy was associated with a severe clinical presentation of DNI. Older age (≥65 years old), multiple spaces (≥3 spaces), and presence of mediastinitis were significant risk factors associated with tracheostomy in patients with DNI. The parapharyngeal and retropharyngeal spaces were the most commonly involved, and Streptococcus constellatus was the most common pathogen in the patients with DNI that required tracheostomy.
Highlights
Deep neck infection (DNI) is a fatal bacterial infection in the potential spaces of the neck [1]
This study retrospectively reviewed the medical records of 403 patients diagnosed with DNI who were admitted to Chang Gung Memorial Hospital in Linkou, Taiwan, between September 2016 and February 2020
Older age (≥65 years old) (OR = 2.450, 95% CI: 1.163–5.161, p = 0.018), multiple spaces (≥3 spaces) (OR = 4.490, 95% CI: 2.153–9.360, p = 0.001), and presence of mediastinitis (OR = 14.800, 95% CI: 5.097–42.972, p < 0.001) were significant independent risk factors for tracheostomy in patients with DNI
Summary
Deep neck infection (DNI) is a fatal bacterial infection in the potential spaces of the neck [1]. DNI can lead to airway obstruction and cause severe morbidity and mortality. Securing the airway is critical to manage DNI [2]. Intubation and tracheostomy are the most common types of airway management strategies. Tracheostomy is indicated when conventional intubation is difficult, such as with obvious signs of an obstructed upper airway, severe oral trismus, distorted anatomy of the neck, serious pharyngeal wall bulging, or critical laryngeal edema. Prolonged intubation of more than 2 weeks may be an indication for tracheostomy
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