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01.07.2015 | Original | Ausgabe 7/2015

Intensive Care Medicine 7/2015

Clinical and imaging factors associated with severe complications of cervical necrotizing fasciitis

Zeitschrift:
Intensive Care Medicine > Ausgabe 7/2015
Autoren:
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, Alexandre Mebazaa
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00134-015-3830-1) contains supplementary material, which is available to authorized users.
Take-home message: In an ICU cohort of patients with cervical necrotizing fasciitis, a CT scan on admission revealed severe cervical and mediastinal complications in half of the patients. Those complications might be avoidable as they were associated, at least partially, with prehospital oral glucocorticoids intake.

Abstract

Purpose

Cervical 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.

Methods

We 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.

Results

A 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.

Conclusions

Our 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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