Descending necrotizing mediastinitis complicating deep neck abscesses: clinical features and prognostic assessment in 45 ICU patients

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Deep neck abscess; Descending necrotizing mediastinitis; Intensive care; Mortality; Prognosis.