[Nosocomial sinusitis and nasotracheal intubation. Prospective study of 53 patients]

The authors studied the frequency of sinusitis in nasotracheally intubated patients in an Intensive Care Unit. All patients intubated nasotracheally during an 8 day period were included in a prospective study which included CT scanning with views of all the paranasal sinuses. Sinusitis was defined as opacification of the sinus with an air-fluid level. Transantral punctures were performed in cases of maxillary sinusitis. Fifty-three patients were included. Local symptoms and/or unexplained fever were present in 22% of cases. CT scanning showed sinusitis in 49 of the 53 cases (pansinusitis 42 cases, maxillary alone 5 cases, sphenoidal 16 cases). Bacteriological cultures of sinus punctures were positive in 39 cases, monomicrobial in 21 and polymicrobial in 18 cases. Twenty of the 53 patients developed a lower respiratory tract infection with the same germ and 10 developed septicemia (3 with isolated sinusitis and 7 with pneumonia). Eighteen patients died (6 of their infection and 12 of the underlying disease). This study shows the high frequency of bacterial sinusitis and the necessity of sinus puncture for bacteriological identification of the causal organism to adapt antibiotic therapy.