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



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).


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


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).


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.


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%).


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.


Infections Nosocomial Sinusitis Nosocomial sinusitis Maxillary sinusitis Ventilator associated pneumonia 


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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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