Prevention of nosocomial maxillary sinusitis in the ICU: the effects of topically applied alpha-adrenergic agonists and corticosteroids.
OBJECTIVE
We investigated the efficacy of locally applied nasal decongestant agents and corticosteroids for preventing nosocomial maxillary sinusitis in mechanically ventilated patients with multiple trauma.


METHODS
A prospective, open-label randomized study in two intensive care units (ICUs).


METHODS
79 consecutive multiple trauma patients admitted to the ICU who were expected to be mechanically ventilated for more than 3 days.


METHODS
Patients were randomly assigned to receive either a combination of a locally applied nasal decongestant agents: 2 drops twice/day of xylometazoline nasal solution 0.1% and 100microg budesonide (NDCA group, n=39) or placebo (control group, n=40).


METHODS
For the diagnosis of radiological maxillary sinusitis patients underwent paranasal computed tomography within 48h of admission and thereafter every 4-7 days. Infectious maxillary sinusitis was diagnosed by microbiological analysis of fluid aspirated after transnasal puncture of maxillary sinuses.


RESULTS
Radiological maxillary sinusitis was detected in 54% of patients in the NDCA group (n=21) but in 82% of controls (p<0.01), and infectious maxillary sinusitis in 8% of the NDCA group (n=3) but in 20% of controls (n=8; p=0.11). The most common pathogen micro-organisms identified from maxillary aspirates were Acinetobacter (32%) followed by anaerobes (21%).


CONCLUSIONS
Our results indicate that the combination of locally applied xylometazoline hydrochloride and budesonide reduces the incidence of radiological maxillary sinusitis and may reduce also that of nosocomial maxillary sinusitis in mechanically ventilated patients with multiple trauma.
Pneumatikos
Ioannis
I
Department of Intensive Care Unit, University Hospital of Alexandroupolis, 68100, Dragana, Greece. ipnevmat@med.duth.gr
Konstantonis
Dimitrios
D
Tsagaris
Iraklis
I
Theodorou
Vasiliki
V
Vretzakis
Georgios
G
Danielides
Vasilios
V
Bouros
Demosthenes
D
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D001421:Bacteria, Anaerobic / Q000187:drug effects / Q000302:isolation & purification; D003428:Cross Infection / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006115:Greece; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D015523:Maxillary Sinusitis / Q000188:drug therapy / Q000517:prevention & control*; D008875:Middle Aged; D011446:Prospective Studies
D000305:Adrenal Cortex Hormones; D000316:Adrenergic alpha-Agonists