Intensive Care Medicine

, Volume 32, Issue 4, pp 532–537 | Cite as

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

  • Ioannis Pneumatikos
  • Dimitrios Konstantonis
  • Iraklis Tsagaris
  • Vasiliki Theodorou
  • Georgios Vretzakis
  • Vasilios Danielides
  • Demosthenes Bouros
Original

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

Infections Nosocomial Sinusitis Nosocomial sinusitis Maxillary sinusitis Ventilator associated pneumonia 

References

  1. 1.
    Holzapfel L, Chervet S, Mandinier G, Madinier G, Ohen F, Demingeon G, Coupry A, Chaudet M (1993) Influence of long term oro or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: a prospective randomized clinic trial. Crit Care Med 21:1132–1138PubMedCrossRefGoogle Scholar
  2. 2.
    Rouby JJ, Laurent P, Gosnach M, Cambau E, Lamas G, Zouaoui A, Leguilou J-L, Bodin L, Khac TD, Marsault C, Poete P, Nikolas M-H, Jarlier V, Viars P (1994) Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Respir Crit Care Med 150:776–783PubMedGoogle Scholar
  3. 3.
    Le Moal G, Lemerre D, Grollier G, Desmont C, Klossek J-M Robert R (1999) Nosocomial sinusitis with isolation of anaerobic bacteria in ICU patients. Intensive Care Med 25:1066–1071CrossRefPubMedGoogle Scholar
  4. 4.
    Holzapfel L, Chastang C, Demingeon G, Bohe J, Piralla B, Coupry A (1999) A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Am J Respir Crit Care Med 159:695–701PubMedGoogle Scholar
  5. 5.
    Sourweine B, Mom T, Traore O, Aublet-Cuvelier B, Bret l, Sirot J, Beteix P, Gilain L, Boyer L (2000) Ventilator associated sinusitis: microbiological results of sinus aspirates in patients on antibiotics. Anesthesiology 93:1255–1260PubMedCrossRefGoogle Scholar
  6. 6.
    Bert F, Lambert -Zechovsky N (1995) Microbiology of nosocomial sinusitis in intensive care unit patients. J Infect 31:5–8CrossRefPubMedGoogle Scholar
  7. 7.
    Westergren V, Lundbland L, Forsum U (1998) Ventilator-associated sinusitis: antroscopic findings and bacteriology when excluding contaminants. Acta Otolaryngol (Stockh) 118:547–580CrossRefGoogle Scholar
  8. 8.
    Talmor M, Lip P, Barie PS (1997) Acute paranasal sinusitis in critically ill patients: Guidelines for prevention, diagnosis and treatment. Clin Infect Dis 24:1441–1446CrossRefGoogle Scholar
  9. 9.
    Geiss HK (1999) Nosocomial sinusitis. Intensive Care Med 25:1037–1039CrossRefPubMedGoogle Scholar
  10. 10.
    Pneumatikos I, Koulouras V, Nathanail C, Goe D, Nakos G (2002) Selective decontamination of subglottic area in mechanically ventilated patients with multiple trauma. Intensive Care Med 28:432–437CrossRefPubMedGoogle Scholar
  11. 11.
    Aust R, Drettner B (1974) The functional size of the human maxillary ostium in vivo. Acta Otolaryngol (Stockh) 78:432–435CrossRefGoogle Scholar
  12. 12.
    Aust R, Drettner B (1975) The patency of the maxillary ostium in relation to body posture. Acta Otolaryngol (Stockh) 80:443–446CrossRefGoogle Scholar
  13. 13.
    Aust R, Stierna P, Drettner B (1994) Basic experimental studies of ostial patency and local metabolic environment of the maxillary sinus. Acta Otolaryngol Suppl (Stockh) 515:7–10CrossRefGoogle Scholar
  14. 14.
    Deja M, Busch T, Bachmann S, Riskowski K, Campean V, Wiedmann B, Schwabe M, Hell B, Pheilschifter J, Falke K, Lewandowski K (2003) Reduced Nitric oxide in sinus epithelium of patients with radiologic sinusitis and sepsis. Am J Respir Crit Care Med 168:281–286CrossRefPubMedGoogle Scholar
  15. 15.
    Arens JF, LeJeune FE, Webre DR (1974) Maxillary sinusitis a complication of nasotracheal intubation. Anesthesiology 40:415–416PubMedCrossRefGoogle Scholar
  16. 16.
    Gallagher TJ, Civetta JM (1976) Acute maxillary sinusitis complicating nasotracheal intubation: a case report. Anesth Analg 55:885–886PubMedCrossRefGoogle Scholar
  17. 17.
    Knodel AR, Beekaman JF (1982) Unexplained fever in patients with nasotracheal intubation. JAMA 248:868–870CrossRefPubMedGoogle Scholar
  18. 18.
    Deutschman CS, Wilton PB, Snow J et al. (1985) Paranasal sinusitis: a common complication of nasotracheal intubation in neurosurgical patients. Neurosurgery 17:296–299PubMedCrossRefGoogle Scholar
  19. 19.
    Castellano F, Mautone G (2002) Decongestant activity of a new formulation of xylometazoline nasal spray: a double-blind, randomized versus placebo and reference drugs controlled dose-effect study. Drugs Exp Clin Res 28:27–35PubMedGoogle Scholar
  20. 20.
    Westerveld GJ, Scheeren RA, Dekker I, Griffioen DH, Voss HP, Bast A (1995) Anti-oxidant actions of oxymethazoline and xylomethazoline. Eur J Pharmacol 291:27–31PubMedCrossRefGoogle Scholar
  21. 21.
    Graf P, Juto JE (1995) Sustained use of xylometazoline nasal spray shortens the decongestive response and induces rebound swelling. Rhinology 33:14–17PubMedGoogle Scholar
  22. 22.
    Ferguson BJ, Paramaesvaran S, Rubinstein E (2001) A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa. Otolaryngol Head Neck Surg 125:253–260CrossRefPubMedGoogle Scholar
  23. 23.
    Bert F, Lambert-Zechovsky N (1996) Sinusitis in mechanically ventilated patients and its role in the pathogenesis of nosocomial pneumonia. Eur J Clin Microbiol Infect Dis 15:533–544PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Ioannis Pneumatikos
    • 1
  • Dimitrios Konstantonis
    • 1
  • Iraklis Tsagaris
    • 1
  • Vasiliki Theodorou
    • 1
  • Georgios Vretzakis
    • 1
  • Vasilios Danielides
    • 2
  • Demosthenes Bouros
    • 3
  1. 1.Department of Intensive Care UnitUniversity Hospital of AlexandroupolisDraganaGreece
  2. 2.Department of OtorhinolaryngologyUniversity Hospital of AlexandroupolisDraganaGreece
  3. 3.Department of PneumonologyUniversity Hospital of AlexandroupolisDraganaGreece

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