The efficacy of functional endoscopic sinus surgery in the evolution of fever of unknown origin in ICU patients.
CONCLUSIONS
Functional endoscopic sinus surgery (FESS) was found to be effective in treating fever of unknown origin (FUO) in intensive care unit (ICU) patients with rhinosinusitis, with 62% of patients showing improvement within 5 days of the procedure.


OBJECTIVE
To correlate improvement in FUO with FESS drainage of the paranasal sinuses.


METHODS
Fifty patients that developed FUO during ICU stay, with CT findings suggestive of rhinosinusitis, and showed no improvement in fever after clinical treatment underwent FESS for drainage of the paranasal sinuses and were evaluated for postoperative improvement of fever.


RESULTS
The study sample consisted of 50 patients (74% of whom were male, mean age 48.1 years). The most frequent diagnoses at ICU admission were tetanus, pulmonary disease, and cardiovascular disease. In all, 68% of patients underwent nasogastric or enteral intubation. CT scanning most commonly showed involvement of the sphenoid sinus. In 54% of cases, sinusitis was bilateral and extended throughout the maxillary, ethmoidal, and sphenoidal sinuses. Sinusectomy was performed in all patients, and pathological secretion in the paranasal sinuses was seen in 52% of patients during surgery. Gram-negative bacteria were the most commonly isolated organisms, followed by Gram-positive bacteria and fungi. Improvement of fever was found in 82% of patients after FESS; 38% of these improved within the first 48 h post-procedure, and the remaining 62% within the first 5 postoperative days.
Department of Otorhinolaryngology, School of Medicine of University of São Paulo, São Paulo, Brazil. franciniotorrino@gmail.com
Francini G M
FG
Pádua
Thiago F P
TF
Bezerra
Richard L
RL
Voegels
Ricardo F
RF
Bento
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D004322:Drainage; D004724:Endoscopy; D005260:Female; D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012220:Rhinitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012852:Sinusitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult