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Ventilator-associated sinusitis: a review

V Westergren1, L Lundblad, H B Hellquist

  • 1Department of Ear and Skin, Karolinska Institute, Stockholm, Sweden.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|November 3, 1998
PubMed
Summary
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Nasotracheal tubes in intensive care are not a primary cause of bacterial sinusitis. Critically ill patients often show inflammation without infection, with bacterial presence indicating colonization, not disease.

Area of Science:

  • Critical Care Medicine
  • Otolaryngology
  • Infectious Diseases

Background:

  • Nasotracheal tubes are frequently cited as a cause of bacterial sinusitis in intensive care units (ICUs).
  • Previous studies reported high rates of bacterial culture positivity, but patient condition in ICUs complicates interpretation.
  • Antibiotic use and ICU flora can interfere with standard diagnostic methods for sinusitis.

Purpose of the Study:

  • To re-evaluate the association between nasotracheal tubes and bacterial sinusitis in critically ill patients.
  • To differentiate between true infection and colonization in the paranasal sinuses of ICU patients.
  • To establish accurate diagnostic criteria for sinusitis in the intensive care setting.

Main Methods:

  • Employed new sampling and quantitative culturing techniques for intensive care antral diagnostics.

Related Experiment Videos

  • Combined microbiological sampling with endoscopic inspection of the sinuses.
  • Evaluated patients requiring mechanical ventilation for one week or longer.

    • Main Results:

    • Bacterial sinusitis occurred in less than 10% of patients on mechanical ventilation for at least one week.
    • Approximately 80% of examined sinuses showed inflammatory reactions without clinical signs of infection.
    • Positive bacterial cultures in these cases represented colonization rather than active infection.

    Conclusions:

    • Nasotracheal intubation is not a significant cause of bacterial sinusitis in critically ill patients.
    • Inflammatory changes in the sinuses are common in ICU patients but often not indicative of infection.
    • Distinguishing colonization from infection is crucial for accurate diagnosis and treatment in intensive care settings.