Sinusitis in the critical care patient

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Otolaryngology

Background:

• Paranasal sinus infections are an underrecognized source of sepsis in critically ill patients.
• Communication barriers in these patients prevent typical sinusitis symptoms like facial pain.
• Sepsis can be the primary clinical presentation of occult sinusitis.

Purpose of the Study:

• To highlight paranasal sinusitis as a potential cause of sepsis in critical care.
• To emphasize the importance of considering sinusitis in patients with unexplained fever.
• To outline diagnostic and therapeutic strategies for critical care sinusitis.

Main Methods:

• Review of clinical presentations and predisposing factors for sinusitis in critical care.
• Discussion of diagnostic modalities including radiologic imaging (plain radiographs, CT scans).
• Emphasis on maxillary sinus lavage for diagnosis and culture.

Main Results:

• Nasotracheal intubation is a significant risk factor for developing sinusitis in this population.
• Infections are frequently polymicrobial, with a notable prevalence of Gram-negative organisms like Pseudomonas aeruginosa.
• Radiologic studies often reveal sinus inflammation or fluid, aiding diagnosis.

Conclusions:

• Clinicians must maintain a high index of suspicion for sinusitis in critical care patients with fever of unknown origin.
• Management involves prompt removal of nasal tubes, appropriate antibiotics, and decongestants.
• Surgical drainage may be required in some cases; avoiding nasotracheal intubation is recommended for immunocompromised or prolonged intubation (>7 days).