[Upper respiratory tract infections in patients with tracheal intubation].
Nosocomial sinusitis (NS) is observed in 10 to 30 per cent of patients under mechanical ventilation (MV) and in up to 40 per cent in those with nasotracheal intubation. This complication occurs in the first two weeks of MV in 3 out of 4 cases. Apart from a pyrexia, the clinical signs are inconsistent. Radiography at the bedside using a cradle to immobilize the head, shows either opacification of the sinus or a fluid-air level. Cerebral CT scanning is justified when intracranial extension of the infection is suspected. NS is the source of many complications: parasinusitis, intracranial infection, septicemia, and, above all, nosocomial pneumonia. The treatment requires withdrawal of nasal tubes, cleaning the nostrils, nasal decongestants and drainage after transmeatal puncture. The latter procedure enables samples of pus to be taken for bacteriological investigation. The potential gravity of NS justifies a systematic work-up in all patients on MV and strict surveillance of the efficacy of the chosen treatment.
Boles
J M
JM
Service de réanimation médicale, urgences et maladies infectieuses, Centre hospitalier régional et universitaire, Brest.
D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D012121:Respiration, Artificial / Q000009:adverse effects; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012852:Sinusitis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
Les infections des voies aériennes supérieures chez les sujets intubés.