Paranasal sinusitis and sepsis in ICU patients with nasotracheal intubation.
During a 1-year period 4 out of 171 nasotracheally intubated patients (2.3%) developed sepsis due to purulent sinusitis. 98 (57%) of the patients received mechanical ventilation for more than 10 days. In all cases of sinusitis the diagnosis could be confirmed by conventional X-ray examination. Sepsis resolved 1 to 3 days after initiation of a therapy protocol consisting of tracheostomy, surgical drainage and lavage. Pseudomonas aeruginosa was involved as pathogenic organism in 3 of 4 patients. We conclude that purulent sinusitis represents a serious and often occult problem in already critically ill patients with multiple potential sources of sepsis. Most important for diagnosis is a high level of suspicion particularly in patients with risk factors for infection. Prompt and successful treatment can be achieved by an aggressive surgical approach.
Aebert
H
H
Department of Surgery, Hannover Medical School, FRG.
Hünefeld
G
G
Regel
G
G
D000328:Adult; D003422:Critical Care; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000209:etiology* / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects; D012852:Sinusitis / Q000150:complications* / Q000209:etiology / Q000628:therapy