Related Experiment Videos
[Sinusitis as a major cause of fever in intubated patients]
A Vonk Noordegraaf1, R R de Bree, R J van Schijndel
1Afd. Longziekten, VU Medisch Centrum, Postbus 7057, 1007 MB Amsterdam. a.vonk@vumc.nl
Abstract:
Because sinusitis is usually clinically silent in intubated patients, it is not widely appreciated as an important source of infection and fever in critically ill patients. Three such patients, two men aged 22 and 36 years, and a woman aged 50 years, suffered from respiratory insufficiency due to pneumonia. The course of the disease was determined by the sinusitis, which did not resolve during antibiotic therapy of the pneumonia, notwithstanding the fact that the causative micro-organism was susceptible to the antibiotics administered, and that both the tracheal and gastric tubes were led through the mouth instead of the nose. Flushing of the sinuses caused the fever to disappear and led to recovery of the patients. An aggressive approach to diagnose sinusitis in the intubated patient with fever in the intensive care unit is needed. A maxillary sinus lavage and culture, followed by treatment with specific antibiotics should be an integral part of the diagnosis and treatment in these patients. Surgery is indicated in the event of persistent sepsis.
Insights
Sinusitis can be a hidden cause of fever in intubated patients. Prompt diagnosis and treatment, including sinus lavage, are crucial for recovery in intensive care units.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Otolaryngology
Background:
- Sinusitis is often asymptomatic in intubated patients, making it an underrecognized source of infection.
- Fever in critically ill, intubated patients can stem from various sources, complicating diagnosis.
Observation:
- Three intubated patients with pneumonia developed persistent fever despite appropriate antibiotic treatment.
- The unresolved fever was linked to undiagnosed sinusitis, unaffected by standard pneumonia therapy.
- Tracheal and gastric tubes were placed orally, not nasally, yet sinusitis developed.
Findings:
- Maxillary sinus lavage and culture revealed sinusitis as the cause of persistent fever.
- Flushing the sinuses and targeted antibiotic treatment led to fever resolution and patient recovery.
- Aggressive diagnosis of sinusitis is essential in febrile, intubated intensive care unit patients.
Implications:
- Maxillary sinus lavage and culture should be routine in diagnosing fever of unknown origin in intubated patients.
- Early identification and treatment of sinusitis can prevent prolonged critical illness and sepsis.
- Surgical intervention may be necessary for refractory cases of sinusitis-associated sepsis.