Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill.

TLDR

The study prospectively evaluated 162 mechanically ventilated ICU patients, performing baseline and 7‑day follow‑up CT scans to classify maxillary sinus status into normal, mucosal thickening, or radiologic sinusitis, with randomized intubation routes, tube maintenance, transnasal puncture for bacteriology, and a control group of 45 spontaneously breathing patients. Only 25% of patients had normal sinuses at inclusion, and after 7 days 46% of those with mucosal thickening progressed to radiologic sinusitis, with nasal intubation and longer intubation duration identified as risk factors. Abstract truncated at 250 words.

Abstract

The incidence of infectious maxillary sinusitis (IMS) and its clinical relevance was prospectively studied in 162 consecutive critically ill patients who were mechanically ventilated for a period longer than 7 d. All had a paranasal computed tomographic (CT) scan within 48 h of admission and were divided into three groups according to the radiologic aspect of their maxillary sinuses: Group 1 = normal maxillary sinuses (n = 40), Group 2 = maxillary mucosal thickening (n = 26), Group 3 = radiologic maxillary sinusitis (RMS) defined as the presence of an air fluid level and/or opacification of maxillary sinuses (n = 96). Group 1 patients were randomized between nasal and oral endotracheal intubation with a gastric intubation performed via the same route and had a second paranasal CT scan 7 d later. Endotracheal and gastric tubes were left in their original position in Group 2 patients and a second paranasal CT scan was performed 7 d later. All patients of Group 3 underwent a transnasal puncture for bacteriologic analysis of maxillary sinus content. Forty-five spontaneously breathing patients served as a control group. In all patients with RMS, the occurrence of bronchopneumonia (BPN) was prospectively assessed for 7 d following the initial CT scan. Upon inclusion, only 25% of the patients had normal maxillary sinuses whereas all patients in the control group had normal paranasal CT scans. After 7 d, 46% of Group 2 patients had evidence of RMS. Risk factors for RMS were nasal placement and duration of endotracheal and gastric intubation. (ABSTRACT TRUNCATED AT 250 WORDS)