title: Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill.
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)
authors.affiliation: Unité de Réanimation Chirurgicale (Department of Anesthesiology), Hôpital de la Pitié-Salpétrière, Université Paris VI, France.
authors.forename: J J
authors.initials: JJ
authors.lastname: Rouby
authors.forename: P
authors.initials: P
authors.lastname: Laurent
authors.forename: M
authors.initials: M
authors.lastname: Gosnach
authors.forename: E
authors.initials: E
authors.lastname: Cambau
authors.forename: G
authors.initials: G
authors.lastname: Lamas
authors.forename: A
authors.initials: A
authors.lastname: Zouaoui
authors.forename: J L
authors.initials: JL
authors.lastname: Leguillou
authors.forename: L
authors.initials: L
authors.lastname: Bodin
authors.forename: T D
authors.initials: TD
authors.lastname: Khac
authors.forename: C
authors.initials: C
authors.lastname: Marsault
mesh_terms: D000328:Adult; D001996:Bronchopneumonia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D016638:Critical Illness; D003428:Cross Infection / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging; D015523:Maxillary Sinusitis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed