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[Upper respiratory tract infections in patients with tracheal intubation]
1Service de réanimation médicale, urgences et maladies infectieuses, Centre hospitalier régional et universitaire, Brest.
Abstract:
Nosocomial sinusitis (NS) is observed in 10 to 30 per cent of patients under mechanical ventilation (MV) and in up to 40 per cent in those with nasotracheal intubation. This complication occurs in the first two weeks of MV in 3 out of 4 cases. Apart from a pyrexia, the clinical signs are inconsistent. Radiography at the bedside using a cradle to immobilize the head, shows either opacification of the sinus or a fluid-air level. Cerebral CT scanning is justified when intracranial extension of the infection is suspected. NS is the source of many complications: parasinusitis, intracranial infection, septicemia, and, above all, nosocomial pneumonia. The treatment requires withdrawal of nasal tubes, cleaning the nostrils, nasal decongestants and drainage after transmeatal puncture. The latter procedure enables samples of pus to be taken for bacteriological investigation. The potential gravity of NS justifies a systematic work-up in all patients on MV and strict surveillance of the efficacy of the chosen treatment.
Insights
Nosocomial sinusitis (NS), common in mechanically ventilated patients, often develops within two weeks. Early diagnosis and treatment are crucial to prevent serious complications like pneumonia.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Otolaryngology
Context:
- Nosocomial sinusitis (NS) affects 10-30% of patients on mechanical ventilation (MV).
- Up to 40% of patients with nasotracheal intubation develop NS.
- The complication typically occurs within the first two weeks of MV.
Purpose:
- To review the incidence, clinical presentation, diagnostic methods, and complications of nosocomial sinusitis.
- To outline appropriate treatment strategies for NS in mechanically ventilated patients.
Summary:
- Clinical signs of NS are often inconsistent, with fever being the primary indicator.
- Radiography can reveal sinus opacification or fluid-air levels; CT scanning is indicated for suspected intracranial extension.
- NS can lead to severe complications, including sepsis, intracranial infections, and nosocomial pneumonia.
Impact:
- Highlights the need for systematic work-up and surveillance in MV patients.
- Emphasizes prompt treatment, including nasal tube removal and transmeatal drainage, to mitigate risks.
- Underscores the potential gravity of NS and its impact on patient outcomes.