Methods:

this study, conducted in a tertiary hospital in Bolivia, proposes two algorithms and a structured, systematic approach to optimize the multidisciplinary management of these patients, validated through the Delphi method. A retrospective analysis of 28 DNM cases over ten years (2014-2023) showed that 50% originated from dental infections, with a mortality rate of 21,42%. Key risk factors included: age over 60 years (OR=14), diabetes combined with another chronic disease (OR=9), a delay of >14 days in seeking medical attention (OR=10,7), and ICU stays of >21 days (OR=9).

Results:

the proposed management strategy was validated through surveys of 30 specialists (surgeons, intensivists, etc.), evaluating three dimensions: preoperative, intraoperative, and postoperative care. Aiken's V demonstrated consensus levels of 90%; 92,1%, and 95,5% respectively, while Cronbach's alpha confirmed high reliability (0.801). The key algorithmic strategies include initial stabilization by internal medicine, early combined cervico-thoracic surgery, and standardized ICU follow-up protocols.

Conclusions:

the discussion emphasizes the importance of early diagnosis, aggressive surgical intervention, and multidisciplinary collaboration to reduce mortality rates. This systematic approach could improve patient care in tertiary hospitals, especially in areas with a high incidence of poorly managed dental infections.

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