title: Ventilator-associated sinusitis in adults: systematic review and meta-analysis.
abstract: OBJECTIVE
  To review the epidemiology, risk factors for, treatment and outcome of ventilator-associated sinusitis (VAS).
  
  
  METHODS
  We performed a systematic review and meta-analysis of available data without time restrictions. A conservative random effects model was employed to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Out of 620 retrieved reports, 31 papers fulfilled our inclusion criteria. Infectious sinusitis affects 27% of mechanically ventilated patients and was found to be the cause of undetermined fever in 25% of the cases. Although radiographic VAS was higher in nasotracheally compared to orotracheally intubated patients (OR 4.66, 95% CI 1.35-16.13), clinical VAS was not (3.67, 0.80-6.81). The presence of VAS has been associated with the presence of VAP (3.66, 1.81-7.37) or bacteremia (6.85, 2.14, 21.92); however, it is unknown whether an etiologic relationship between them exists. In patients with concomitant VAS and VAP or bloodstream infections identical pathogens are isolated in 59% and 20% of the cases, respectively. The presence as opposed to absence of VAS was not associated with excess mortality (1.02, 0.35-3.01).
  
  
  CONCLUSIONS
  VAS is a common infection in critically ill adults and correlates with other important infectious complications.
authors.affiliation: Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Agrafiotis
authors.forename: Konstantinos Z
authors.initials: KZ
authors.lastname: Vardakas
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Gkegkes
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kapaskelis
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D016470:Bacteremia / Q000209:etiology; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012852:Sinusitis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012122:Ventilators, Mechanical / Q000009:adverse effects*