Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill

Am J Respir Crit Care Med. 1994 Sep;150(3):776-83. doi: 10.1164/ajrccm.150.3.8087352.


The incidence of infectious maxillary sinusitis (IMS) and its clinical relevance was prospectively studied in 162 consecutive critically ill patients who were mechanically ventilated for a period longer than 7 d. All had a paranasal computed tomographic (CT) scan within 48 h of admission and were divided into three groups according to the radiologic aspect of their maxillary sinuses: Group 1 = normal maxillary sinuses (n = 40), Group 2 = maxillary mucosal thickening (n = 26), Group 3 = radiologic maxillary sinusitis (RMS) defined as the presence of an air fluid level and/or opacification of maxillary sinuses (n = 96). Group 1 patients were randomized between nasal and oral endotracheal intubation with a gastric intubation performed via the same route and had a second paranasal CT scan 7 d later. Endotracheal and gastric tubes were left in their original position in Group 2 patients and a second paranasal CT scan was performed 7 d later. All patients of Group 3 underwent a transnasal puncture for bacteriologic analysis of maxillary sinus content. Forty-five spontaneously breathing patients served as a control group. In all patients with RMS, the occurrence of bronchopneumonia (BPN) was prospectively assessed for 7 d following the initial CT scan. Upon inclusion, only 25% of the patients had normal maxillary sinuses whereas all patients in the control group had normal paranasal CT scans. After 7 d, 46% of Group 2 patients had evidence of RMS. Risk factors for RMS were nasal placement and duration of endotracheal and gastric intubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Bronchopneumonia / diagnostic imaging
  • Bronchopneumonia / epidemiology
  • Bronchopneumonia / etiology
  • Critical Illness
  • Cross Infection / diagnostic imaging
  • Cross Infection / epidemiology*
  • Cross Infection / etiology
  • Female
  • Humans
  • Incidence
  • Intubation, Gastrointestinal / adverse effects
  • Intubation, Gastrointestinal / statistics & numerical data
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / statistics & numerical data
  • Logistic Models
  • Male
  • Maxillary Sinus / diagnostic imaging
  • Maxillary Sinusitis / diagnostic imaging
  • Maxillary Sinusitis / epidemiology*
  • Maxillary Sinusitis / etiology
  • Middle Aged
  • Paris / epidemiology
  • Prospective Studies
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / statistics & numerical data
  • Risk Factors
  • Time Factors
  • Tomography, X-Ray Computed