Airway management, intensive care requirement, and corticosteroid use in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) study

MTReC Writing Group, Rebecca Exley (Lead / Corresponding author), Greg Logan, Samuel Kent, Chris McDonald, Anusha Hennedige, Alastair Henry, Basim Dawoud, Raghav Kulkarni, Panos Kyzas, Roderick Morrison, Jim McCaul, MTReC Collaborative, Dirk Stephanus Brandsma, Helen Cashman, Aoife Swain, Kapil Java, Gauri Vithlani, Melanie Watson, Mark ChristopherSusan Murray, Gabriele Baniulyte, Jamie Grant, Sam Wareing, Alex Kawalec, Teresa Ng, Nagarjuna Reedy, Milad Tavakoli, Charlotte Underwood, Siddharth Gowrishankar, Tim Collins, Rhodri Davies, Sharonjeet Uppal, Ross Elledge, Syca Shaheen, Rory O'Connor, Hudson King, Ben Tudor-Green, Montey Garg, Jonathan Wareing, Catherine Wicks, Oliver Mitchell, Marwa Maarouf, Priya Chohan, Rachael Otukoya, Eiling Wu, Saadia Farooq, Esther Brewer, Samuel King, Baljeet Nandra, Sam Stevenson, David Young

Research output: Contribution to journalArticlepeer-review

Abstract

Cervicofacial infection (CFI) is a frequently encountered presentation to Oral and Maxillofacial Departments (OMFS). The United Kingdom has recently seen cessation of all routine community dental treatment due to the Coronavirus (COVID-19) pandemic and consequently an initial modification of treatment received in secondary care. Subsequent airway difficulties and the need for level 2 High Dependency Unit (HDU) or level 3 Intensive Care Unit (ICU) is a concern to surgeons and anaesthetists alike. The availability of skilled staff and appropriate facilities can be variable. It is imperative to understand the resource implications of CFI with respect to airway management and critical care utilisation. Adequate provision is fundamental for optimal care. A national, multicentre, trainee-led audit was carried out across 17 hospitals in the UK from May to September 2017. Information recorded included demographic features, presentation, airway management, medical and surgical treatment, and steroid administration. One thousand and two presentations (1002) were recorded. Forty-five percent were female, with a mean (range) age of 37.5 years (0–94). Regarding surgical airway management, 63.4% had a standard intubation (oral 42%, nasal 21.4%). Awake fibreoptic intubation (AFOI) was performed in 28% and surgical airway required in 0.9%. Impending airway compromise at the time of presentation was 1.7%. Following surgical incision and drainage, 96.1% of patients returned to a general ward, 2.7% to Level 3, and 1.1% to Level 2 care. The return to theatre was 2.8%, and 0.7% required reintubation. There was an association between corticosteroid administration and duration of intubation. Those who received steroids were more likely to remain intubated postoperatively (p = 0.006), require a higher level of postoperative care (p < 0.001), and require a return to theatre (p = 0.019). Postoperatively, patients who received steroids were less likely to be extubated at the close of the procedure. Intubated patients who received multiple steroid doses postoperatively were extubated with less frequency those that received a single dose. To our knowledge, this dataset is the largest ever recorded for CFI. Our results showed a high requirement for advanced airway management in this cohort. The requirement for surgical airway was low, but the significance of this situation should not be underestimated. The relatively frequent need for care at levels 2 or 3 within this cohort also placed a significant demand on already overburdened resources. Knowledge of care requirements for these patients will inform resource planning.

Original languageEnglish
Pages (from-to)1228-1233
Number of pages6
JournalBritish Journal of Oral and Maxillofacial Surgery
Volume60
Issue number9
Early online date27 Aug 2022
DOIs
Publication statusPublished - Nov 2022

Keywords

  • Airway
  • Cervicofacial infection
  • Corticosteroid
  • Length of stay
  • Level of care
  • Odontogenic infection
  • Tracheostomy

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