[Airway management in Ludwig's angina - a challenge: case report]

The management of septic shock and Ludwig's angina: A case report of a life-threatening condition

Ludwig's angina is a high severity infection because of the risk of airway obstruction due to the rapid spread of the abscess into the deeper spaces. Therefore, performing the correct treatment is one of the keys to a successful result. A 44-year-old male patient came to the Emergency Unit of Hasan Sadikin Hospital, complaining of shortness of breath, severe pain, and progressive swelling. Extraoral examination showed a localized-fluctuated swelling located at the right lower jaw that extended to the chin, left lower jaw, and the frontal region of the neck region while a sequential organ failure assessment revealed a score of 2. A diagnosis of Ludwig's angina and septic shock was confirmed. Intravenous infusion of norepinephrine was administered and a tracheostomy was performed. The next treatment phase consisted of a drainage procedure, tooth extraction, and placement of the Penrose drain. The patient was discharged 10 days later with a satisfactory outcome.

Characteristics and outcomes of Ludwig's angina in patients admitted to the intensive care unit: A 6-year retrospective study of 29 patients

Background/Purpose

Ludwig's angina (LA) still presents regularly and various characteristics are documented, but patients admitted to the Intensive Care Unit (ICU) has not been studied. The purpose of this study was to investigate the clinical characteristics and outcomes of patients with LA who were admitted to ICU.

Materials and methods

We retrospectively reviewed all 29 patients with LA who were admitted to the ICU of a university hospital from January 2013 to October 2018. Results were evaluated via descriptive analysis. The Log–Rank test was used to analyze the hospital/ICU length of stay (LOS).

Results

The male: female ratio was 2.63:1. Mean age was 53.41 ± 16.57 years (range 8–78 years). Concomitant conditions comprised diabetes mellitus in 10 patients (34.48%), and hypertension in six (20.69%). The main reason for ICU admission was surgical (44.83%). The mean Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) scores were 13.52 ± 3.18 and 3.83 ± 2.89, respectively. Twenty-eight patients (96.55%) received respiratory support. Sixteen patients (55.17%) had positive bacterial culture results. Fourteen bacterial strains were detected, most of which were gram-positive (72.72%). Mean LOS was 6.89 ± 14.39 days (range 0.5–73 days), and 24.79 ± 16 days in the hospital. The ICU mortality rate was 10.34%. Compared with LA patients without descending necrotizing mediastinitis (DNM), those with DNM had longer ICU and hospital LOS. The laboratory investigations were higher.

Conclusion

LA patients in ICU were predominantly male, with a wide range age, high incidence of complications, long hospital LOS.