Intensive Care Medicine

, Volume 16, Issue 6, pp 390–393 | Cite as

Nosocomial maxillary sinusitis during mechanical ventilation: A prospective comparison of orotracheal versus the nasotracheal route for intubation

  • F. Salord
  • P. Gaussorgues
  • J. Marti-Flich
  • M. Sirodot
  • C. Allimant
  • D. Lyonnet
  • D. Robert


Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n=53) or nasotracheal (n=58) intubation. All had a nasogastric feeding tube. Patients with head trauma or mechanical ventilation for less than 48h were excluded. Sinusitis diagnosis was made by radiography (waters' view) at the bedside. The two groups were similar in age, SAPS, duration of ventilation. Maxillary sinusitis occurred in 1/53 (1.8%) of the orotracheal group (on the nasogastric tube side), and in 25/58 (43.1%) of the nasotracheal group (7 on the nasogastric tube side, 11 on the endotracheal tube side, 7 bilateral;p<0.001). Nine of the 26 cases of sinusitis were initially treated by sinus drainage because of signs of infection (3 failures) and the 17 others were treated by tube removal. This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p<0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.

Key words

Maxillary sinusitis Nosocomial infection Intubation-related complications 


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  1. 1.
    Caplan ES, Hoyt NJ (1988) Nosocomial sinusitis. JAMA 207:639–641Google Scholar
  2. 2.
    Boles JM, Garo B, Lejeune B, Mériot P, Bensoussan T, Guiavarch M, de Saint Martin L, Garre M (1988) Sinusires nosocomiales chez les malades sous ventilation assistée (Abstr). Réan Soins Intens Med Urg 4:363Google Scholar
  3. 3.
    O'Reilly MJ, Reddick EJ, Black W, Carter PL, Erhardt J, Fill W, Maughn D, Sado A, Klatt GR (1984) Sepsis from sinusitis in nasotracheally intubated patients. A diagnostic dilemma. Am J Surg 147:601–604Google Scholar
  4. 4.
    Carter BL, Bankoff MS, Fisk JD (1983) Computed tomographic detection of sinusitis responsible for intra-cranial and extra-cranial infections. Radiology 147:739–742Google Scholar
  5. 5.
    Grindlinger GA, Niehoff J, Hughes SL, Humphrey MA, Simpson G (1987) Acute paranasal sinusitis related to nasotracheal intubation of head-injuried patients. Crit Care Med 15:214–217Google Scholar
  6. 6.
    Meyer Ph, Guerin JM, Levy C, Habib Y (1988) Sinusites aigues nosocomiales à pyocyanique. Med Mal Infect 18:159–162Google Scholar
  7. 7.
    Deutschman CS, Wilton P, Sinow J, Dibbel D, Konstantinides FN, Cerra F (1986) Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis. Crit Care Med 14:111–114Google Scholar
  8. 8.
    Meyer Ph, Guérin JM, Habib Y, Levy C (1988) Pneumopathies secondaires du sujet intubé par voie nasotrachéale. Role des sinusites nosocomiales. Ann Fr Anesth Réan 7:26–30Google Scholar
  9. 9.
    Riou B, Richard C, Rimailho A, Auzepy P (1986) Septicémie secondaire à une sinusite maxillaire: une complication rare de l'intubation nasotrachéale. Ann Fr Anesth Réan 5:83–84Google Scholar
  10. 10.
    Arens TF, Lejehwe FE, Webre DR (1974) Maxillary sinusitis. A complication of nasotracheal intubation. Anesthesiology 4:415–416Google Scholar
  11. 11.
    Knodel AR, Beekman JF (1982) Unexplained fevers in patients with nasotracheal intubation. JAMA 248:868–870Google Scholar
  12. 12.
    Kronberg F, Goodwin W (1985) Sinusitis in care unit patients. Laryngoscope 95:936–938Google Scholar
  13. 13.
    Depoix JP, Malbezin S, Videcoq M, Hazebroucq J, Barbier-Bohm G, Gauzit R, Desmonts JM (1987) Oral intubation versus nasal intubation in adult cardiac surgery. Br J Anesth 59:167–169Google Scholar
  14. 14.
    Zwillich C, Pierson DJ (1976) Nasal necrosis: a common complication of nasotracheal intubation. Chest 64:376–377Google Scholar
  15. 15.
    Berry F, Blankenbaker W, Ball C (1973) A comparison of bacteremia occurring with nasotracheal and orotracheal intubation. Anesth Analg 6:873–876Google Scholar
  16. 16.
    Dinner M, Tjeuw M, Artusio JF (1987) Bacteremia as a complication of nasotracheal intubation. Anesth Analg 66:460–462Google Scholar
  17. 17.
    Stauffer JL, Olson D, Petty T (1981) Complications and consequences of endotracheal intubation and tracheotomy. Am J Med 70:65–76Google Scholar
  18. 18.
    Zwillich C, Pierson DJ, Creagh CE, Sutton FD, Schatz E, Petty TL (1974) Complications of assisted ventilation: a prospective study of 354 consecutive episodes. Am J Med 57:161–170Google Scholar
  19. 19.
    Dubick M, Wright B (1978) Comparison of laryngeal pathology following long-term oral and nasal endotracheal intubation. Anesth Analg 57:663–668Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • F. Salord
    • 1
  • P. Gaussorgues
    • 1
  • J. Marti-Flich
    • 1
  • M. Sirodot
    • 1
  • C. Allimant
    • 1
  • D. Lyonnet
    • 1
  • D. Robert
    • 1
  1. 1.Intensive Care Unit, Service d'Assistance Respiratoire et de Réanimation MédicaleHôpital de la Croix-RousseLyon Cedex 04France

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