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[Maxillary sinusitis in intensive care patients]
Abstract:
Fever of unknown origin is a major diagnostic problem in traumatologic postoperative intensive care medicine. Even when other causes of fever (wound infection, pneumonia, intravenous catheter contamination) have been ruled out, purulent maxillary sinusitis is rarely considered as the initial focus. The maxillary sinuses of 46 patients admitted to a postoperative intensive care unit were examined using a mobile "A-Scan" ultrasonic scanner. Follow-up examinations were performed on a regular basis. As early as on the 5th day of treatment, the initially, most often nasotracheally intubated and artificially ventilated patients exhibited a high frequency of pathological ultrasonic results, whereas only 10 of the 46 patients within the study demonstrated normal findings throughout the follow-up examinations. As a rule, bilateral involvement was observed. When findings were initially unilateral, the nasally intubated side was most often affected. Early extubation, partial mobilisation and/or administration of antibiotics from the first day of treatment onwards did not prevent the occurrence of pathologic ultrasonic results. Fever and leucocyte count were found to be elevated to a higher level in patients with purulent sinusitis. Thus, affection of the maxillary sinuses appears to be a frequent accompanying disease in intensive care patients, and should therefore always be taken into consideration as the initial focus of fever of unknown origin.
Insights
Purulent maxillary sinusitis is a common cause of fever of unknown origin in postoperative intensive care patients. Early diagnosis via ultrasound is crucial, as standard treatments do not prevent its occurrence.
Area of Science:
- Medical diagnostics
- Intensive care medicine
- Otolaryngology
Context:
- Fever of unknown origin (FUO) presents a significant diagnostic challenge in traumatologic postoperative intensive care units.
- Common causes like infections and catheter contamination are often ruled out, leaving sinusitis overlooked.
- Maxillary sinusitis is rarely considered an initial focus for FUO in this patient population.
Purpose:
- To investigate the frequency and diagnostic utility of purulent maxillary sinusitis as a cause of FUO in postoperative intensive care patients.
- To assess the effectiveness of ultrasonic examination in detecting maxillary sinusitis in intubated and ventilated patients.
- To determine the relationship between purulent sinusitis and fever/leukocyte count in intensive care settings.
Summary:
- A study examined 46 postoperative intensive care patients using ultrasonic scanning to detect maxillary sinusitis.
- Pathological ultrasonic findings were frequent, appearing as early as day 5, particularly in nasotracheally intubated and ventilated patients.
- Bilateral involvement was common; unilateral cases often affected the nasally intubated side. Standard interventions did not prevent sinusitis.
- Patients with purulent sinusitis exhibited higher fever and leukocyte counts.
Impact:
- Highlights purulent maxillary sinusitis as a frequent, often overlooked, cause of FUO in intensive care.
- Emphasizes the need for routine ultrasonic screening of maxillary sinuses in postoperative ICU patients with unexplained fever.
- Suggests that early consideration of maxillary sinusitis can improve diagnostic accuracy and patient management in critical care settings.