Intensive Care Medicine

, Volume 32, Issue 4, pp 532–537

Prevention of nosocomial maxillary sinusitis in the ICU: the effects of topically applied α-adrenergic agonists and corticosteroids

Authors

    • Department of Intensive Care UnitUniversity Hospital of Alexandroupolis
  • Dimitrios Konstantonis
    • Department of Intensive Care UnitUniversity Hospital of Alexandroupolis
  • Iraklis Tsagaris
    • Department of Intensive Care UnitUniversity Hospital of Alexandroupolis
  • Vasiliki Theodorou
    • Department of Intensive Care UnitUniversity Hospital of Alexandroupolis
  • Georgios Vretzakis
    • Department of Intensive Care UnitUniversity Hospital of Alexandroupolis
  • Vasilios Danielides
    • Department of OtorhinolaryngologyUniversity Hospital of Alexandroupolis
  • Demosthenes Bouros
    • Department of PneumonologyUniversity Hospital of Alexandroupolis
Original

DOI: 10.1007/s00134-006-0078-9

Cite this article as:
Pneumatikos, I., Konstantonis, D., Tsagaris, I. et al. Intensive Care Med (2006) 32: 532. doi:10.1007/s00134-006-0078-9

Abstract

Objective

We investigated the efficacy of locally applied nasal decongestant agents and corticosteroids for preventing nosocomial maxillary sinusitis in mechanically ventilated patients with multiple trauma.

Design and setting

A prospective, open-label randomized study in two intensive care units (ICUs).

Patients

79 consecutive multiple trauma patients admitted to the ICU who were expected to be mechanically ventilated for more than 3 days.

Interventions

Patients were randomly assigned to receive either a combination of a locally applied nasal decongestant agents: 2 drops twice/day of xylometazoline nasal solution 0.1% and 100 μg budesonide (NDCA group, n = 39) or placebo (control group, n = 40).

Measurements

For the diagnosis of radiological maxillary sinusitis patients underwent paranasal computed tomography within 48 h of admission and thereafter every 4–7 days. Infectious maxillary sinusitis was diagnosed by microbiological analysis of fluid aspirated after transnasal puncture of maxillary sinuses.

Results

Radiological maxillary sinusitis was detected in 54% of patients in the NDCA group (n = 21) but in 82% of controls (p < 0.01), and infectious maxillary sinusitis in 8% of the NDCA group (n = 3) but in 20% of controls (n = 8; p = 0.11). The most common pathogen micro-organisms identified from maxillary aspirates were Acinetobacter (32%) followed by anaerobes (21%).

Conclusion

Our results indicate that the combination of locally applied xylometazoline hydrochloride and budesonide reduces the incidence of radiological maxillary sinusitis and may reduce also that of nosocomial maxillary sinusitis in mechanically ventilated patients with multiple trauma.

Keywords

InfectionsNosocomialSinusitisNosocomial sinusitisMaxillary sinusitisVentilator associated pneumonia

Copyright information

© Springer-Verlag 2006