[Analysis of risk factors for postoperative prolonged mechanical ventilation in patients with oral and maxillofacial space infection].

OBJECTIVE: To investigate the risk factors associated with prolonged mechanical ventilation (PMV) in patients with oral and maxillofacial space infections (OMSI) treated in the intensive care unit (ICU) after general anesthesia, to establish a predictive model, and to evaluate its predictive value.

METHODS: A retrospective cohort study was performed. OMSI patients who underwent invasive mechanical ventilation and were admitted to the ICU after general anesthesia at The First Affiliated Hospital of Xinjiang Medical University from January 2020 to December 2024 was enrolled. Data including baseline characteristics, medical history, auxiliary examinations, surgical conditions, airway management, initial vital signs within 1 hour after ICU admission, and the first laboratory results after ICU admission were collected. Patients were divided into a non-PMV group (<72 hours) and a PMV group (≥72 hours) according to the duration of mechanical ventilation in the ICU. Clinical data were compared between the two groups. Univariate and multivariate Logistic regression analyses were used to identify risk factors for PMV. A nomogram model was established based on the results of multivariate Logistic regression analysis, and its performance was evaluated using receiver operator characteristic curve (ROC curve), calibration curve, and decision curve analysis (DCA) curve.

RESULTS: A total of 111 OMSI patients were finally included, including 76 males (68.5%) and 35 females (31.5%), with a median age of 55.0 (41.0, 63.5) years. Postoperative PMV occurred in 59 patients (53.2%), and no PMV occurred in 52 patients (46.8%). Significant differences were observed between the two groups in age, Acute Physiology And Chronic Health Evaluation II (APACHE II) score, pre-hospital self-treatment, submental space infection, mediastinal infection, use of vasoactive drugs, preoperative comorbid pneumonia, postoperative complications (pleural effusion, sepsis, pneumonia), number of surgeries, orotracheal intubation, incision of trache, total length of hospital stay, length of ICU stay, and initial body temperature, heart rate, hemoglobin (Hb), blood urea nitrogen (BUN), total protein (TP), albumin (Alb), and inflammatory markers after ICU admission (all P<0.05). Univariate Logistic regression analysis indicated that advanced age, elevated APACHE II score, pre-hospital self-treatment, submental space infection, mediastinal infection, use of vasoactive drugs, preoperative comorbid pneumonia, postoperative complications (pleural effusion, sepsis, pneumonia), ≥2 surgical procedures, orotracheal intubation, prolonged total hospital stay, as well as elevated initial body temperature, heart rate, C-reactive protein (CRP), interleukin-6 (IL-6), and decreased TP and Alb after ICU admission, were influencing factors for PMV (all P<0.05). Multivariate Logistic regression analysis demonstrated that advanced age [odds ratio (OR)=1.05, 95% confidence interval (95%CI) was 1.01-1.09, P=0.027], submental space infection (OR=9.56, 95%CI was 2.53-36.12, P<0.001), use of vasoactive drug (OR=3.58, 95%CI was 1.04-12.35, P=0.044), ≥2 surgical procedures (OR=8.60, 95%CI was 2.26-32.73, P=0.002), orotracheal intubation (OR=11.04, 95%CI was 1.65-74.00, P=0.013), and elevated initial body temperature after ICU admission (OR=6.20, 95%CI was 1.50-25.69, P=0.012) were independent risk factors for postoperative PMV in patients with OMSI. A nomogram model was constructed based on the results of multivariate Logistic regression analysis. ROC curve analysis showed that the model had good predictive performance for PMV [area under the ROC curve (AUC)=0.908, 95%CI was 0.842-0.959, P<0.001], with a sensitivity of 86.4% and a specificity of 80.8%. The calibration curve was close to the ideal curve, suggesting good fitness of the model. DCA showed that the model achieved favorable net clinical benefit within a wide range of threshold probabilities.

CONCLUSIONS: Advanced age, use of vasoactive drug, submental space infection, ≥2 surgical procedures, orotracheal intubation, and elevated initial body temperature after ICU admission are independent risk factors for postoperative PMV in patients with OMSI. The nomogram model established based on these factors shows good predictive value for PMV.