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Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis
Abstract:
Paranasal sinusitis secondary to prolonged nasotracheal intubation represents an infrequently reported source of sepsis. Of 27 nasally intubated patients who developed paranasal sinusitis over a 1-yr period, 17 patients underwent emergency blind nasotracheal intubation post-trauma or shock (group 1) and the remaining ten were intubated electively under operating room or ICU conditions (group 2). Group 1 patients were younger (mean age 33 +/- 6 vs. 57 +/- 5 yr) than those in group 2; they also developed sinusitis more quickly after intubation (mean time 8 +/- 1 vs. 15 +/- 2 days). Diagnosis was confirmed via sinus x-rays (14 cases), computed tomography (five cases), indium scan (two cases), or clinical picture. Cultures were obtained in 14 cases. Staphylococci predominated in group 1, while nosocomial Gram-negative organisms predominated in group 2. Seven patients developed pulmonary infections and two developed systemic sepsis with an organism present on sinus culture. In all cases treatment was successful with antibiotics and tracheostomy or movement of the tube to the oral route. These data indicate that patients nasally intubated are at risk for development of paranasal sinusitis; this diagnosis should be suspected in sepsis of undetermined etiology.
Insights
Prolonged nasotracheal intubation can lead to paranasal sinusitis, a rare cause of sepsis. Early diagnosis and treatment are crucial for patients with sepsis of unknown origin.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Otolaryngology
Background:
- Nasotracheal intubation is a common procedure in critical care.
- Paranasal sinusitis is an infrequently reported complication of nasotracheal intubation.
- Sinusitis can be a source of sepsis, complicating patient management.
Purpose of the Study:
- To investigate the incidence and characteristics of paranasal sinusitis in patients undergoing nasotracheal intubation.
- To identify risk factors and clinical presentations associated with sinusitis in this patient population.
- To highlight the significance of sinusitis as a potential source of sepsis.
Main Methods:
- Retrospective analysis of 27 patients who developed paranasal sinusitis following nasotracheal intubation.
- Classification of patients into emergency (Group 1) and elective (Group 2) intubation groups.
- Diagnostic methods included sinus X-rays, CT scans, indium scans, and clinical assessment.
Main Results:
- Patients undergoing emergency intubation were younger and developed sinusitis earlier than those electively intubated.
- Staphylococci were predominant in the emergency group, while Gram-negative organisms were more common in the elective group.
- Seven patients developed pulmonary infections, and two experienced systemic sepsis originating from sinus infections.
Conclusions:
- Nasotracheal intubation places patients at risk for developing paranasal sinusitis.
- Paranasal sinusitis should be suspected in cases of sepsis with an undetermined etiology.
- Successful treatment involves antibiotics and adjustment of the intubation route.