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Intensive care medicine · Jul 2015
Clinical and imaging factors associated with severe complications of cervical necrotizing fasciitis.
- Hélène Nougué, Anne-Laure Le Maho, Mourad Boudiaf, Jean-Philippe Blancal, Etienne Gayat, Mathieu Le Dorze, Fabrice Vallée, Benjamin Verillaud, Joaquim Mateo, Hakim Kechiche, Claudia Pignataro, Philippe Herman, and Alexandre Mebazaa.
- Mobile Care Unit, Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP, Inserm UMR-S 942, University Paris 7, 2 rue Ambroise Paré, 75010, Paris Cedex 10, France.
- Intensive Care Med. 2015 Jul 1; 41 (7): 1256-63.
PurposeCervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive care unit (ICU) management and prompt surgical treatment to reduce morbidity and mortality. The aim of this study was to estimate the incidence and factors associated with severe complications of CNF.MethodsWe reviewed the medical records of consecutive patients hospitalized in an ICU from 2007 to 2012. The data were collected retrospectively; initial cervical and thoracic computed tomography (CT) scans, performed on admission, were reviewed by an experienced and blinded radiologist to determine CNF complications.ResultsA cohort of 160 patients admitted for CNF was included. The following complications of CNF were found: bilateral extension of CNF (28%), internal jugular vein thrombosis (21%), descending necrotic effusion (14%), mediastinitis (24%), and mortality (4%); 53% had at least one complication, and 48% had at least one cervical complication. On the basis of a univariate analysis, the significant independent factors are odynophagia, dyspnea, oral glucocorticoids intake before admission, and pharyngeal source. Oral nonsteroidal anti-inflammatory drug intake before admission does not have any impact. The initial CNF complications increased both the duration of mechanical ventilation and the length of stay in the ICU. On the basis of a multivariate analysis, the independent factors for severe complications are pharyngeal CNF and oral glucocorticoid intake before admission.ConclusionsOur study demonstrated that an initial cervico-thoracic CT scan revealed a high incidence of cervical and mediastinal CNF complications that all needed immediate management. Those severe complications might be avoidable as they were associated, at least partially, with prehospital oral glucocorticoid intake.
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