Safety of sphenoid aspiration for diagnosis and treatment of intensive care unit rhinosinusitis.
BACKGROUND
In intensive care units (ICUs), critically ill patients may be exposed to several risk factors for developing acute rhinosinusitis, including nasogastric tubes, mechanical ventilation, and prolonged periods in the supine position. The incidence of acute rhinosinusitis can be as high as 83%, the third or fourth most frequent ICU infection and it increases the risk of developing ventilator-associated pneumonia. Diagnosis and therapeutic approaches should be more aggressive than in non-ICU patients. Antral puncture plays a central role in the diagnosis and treatment of these patients. This study was designed to show the development of a method for sphenoid puncture in the diagnosis and treatment of acute infectious rhinosinusitis in critically ill patients, analyzing safety and complications.


METHODS
Patients in ICUs with endoscopic and radiological diagnosis of acute rhinosinusitis were included. Maxillary puncture was performed through the inferior meatus; sphenoid puncture was performed by endoscopic identification of the sphenoethmoidal recess. An aspiration probe was introduced into the natural sphenoidal ostium, followed by aspiration of secretions and saline irrigation.


RESULTS
Twenty-nine patients were included. Twenty-seven patients (93.1%) presented with sphenoidal sinusitis, 24 patients (82.7%) had maxillary sinusitis, 21 patients (72.4%) had ethmoidal sinusitis, and 13 patients (44.8%) had frontal sinusitis. Forty-seven sphenoidal and 39 maxillary punctures were performed. No major bleeding or other complications were recorded.


CONCLUSIONS
The sphenoid puncture is a possible procedure to be performed in an ICU and might complement the paranasal puncture in cases of acute rhinosinusitis.
Department of Otorhinolaryngology, Federal University of São Paulo, SP, Brazil. fvieira65@uol.com.br
Fernando Mirage
FM
Jardim Vieira
Rogério
R
Nunes da Silva
Renato
R
Stefanini
Leonardo Balsalobre
LB
Filho
Rodrigo
R
de Paula Santos
Aldo
A
Stamm
Luiz Carlos
LC
Gregório
D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012220:Rhinitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012852:Sinusitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013101:Sphenoid Sinus