Optimal airway management in the treatment of descending necrotizing
mediastinitis secondary to deep neck infection: Our experiences and
review of literature
Abstract
Objective: To review our experiences of descending necrotizing
mediastinitis (DNM) secondary to deep neck infection (DNI) and determine
appropriate airway management for decreasing mortality and morbidity of
patients with DNM. Study Design: A retrospective study Subjects and
Methods: Medical records of 20 patients (8 women and 12 men) who had
been managed for DNM secondary to DNI between March 2006 and December
2019 were analyzed. Diagnosis and extent of infection were confirmed by
computed tomography of the neck and chest. The upper airway was closely
monitored with a fiberoptic laryngoscope. Complications were evaluated
according to various types of airway management in our serial cases.
Results: Five (25 %) out of 20 patients died as a result of septic
shock and multi-organ failure. None of these patients died from
accidental airway obstruction or airway management mishaps. Keeping
short-term orotracheal intubation was safe and adequate after the
initial surgery. Early tracheotomy was performed for four patients of
all but it was significantly associated with mortality (p=0.032). Three
patients who underwent late tracheotomy had no mortality. Patients with
tracheotomy had longer duration of overall hospital stay than those
without tracheotomy. Conclusions. Well-controlled airway management
might decrease mortality, hospitalization, and airway complications in
patients with DNM secondary to DNI. Keeping orotracheal intubation
rather than upfront tracheotomy should be first considered when managing
airway along with examination of the upper airway with a fiberoptic
laryngoscope.