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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2015

01-07-2015 | Original

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

Authors: 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

Published in: Intensive Care Medicine | Issue 7/2015

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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.
Appendix
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Metadata
Title
Clinical and imaging factors associated with severe complications of cervical necrotizing fasciitis
Authors
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
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 7/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-3830-1

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