Résumé
Background: deep neck infections (DNI) cause swelling and obstruction of the airway, which can make securing the airway challenging. We aimed to describe the various airway management techniques used in this population, identify risk factors for failed intubation, and describe strategies for mechanical ventilation weaning.Method: this retrospective study analyzed all adult patients who underwent surgical treatment for DNI and required invasive mechanical ventilation for more than 24 hours in the intensive care unit (ICU) of two centers, over seven years.Results: among the 91 analyzed patients, 61% were male, with a median age of 52 years and a median SAPS score of 29 on admission. Intubation was performed using direct laryngoscopy (DL) (36%), awake fiberscopy (AF) (28.9%), or video-laryngoscopy (VL) (30%). The choice of intubation technique varied between preoperative evaluation of the mouth opening, centers and changed over time. The rate of first-pass intubation failure was 22% with more desaturation, and no predictive factors for failure could be identified. In ICU, factors associated with extubation failure were pharyngeal or tonsillar origin (p=0.003), mediastinitis (p=0.02), number of surgical revisions (p<0.001) and septic shock (p=0.013). Patients who experience extubation failure have an increased risk of complications, longer mechanical ventilation, and length of stay in the ICU.Conclusion: with awake fiberscopy, videolaryngoscopy could be another appropriate technique to control the airway in patients with severe deep neck infection. Clinical and radiological findings are not reliable predictors of intubation failure on the first attempt. As such, decision-making criteria for airway management should focus on factors such as mouth opening, the expertise of the anesthesiologist, and equipment preference.