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Transnasal puncture based on echographic sinusitis evidence in mechanically ventilated patients with suspicion of nosocomial maxillary sinusitis.

Abstract：

OBJECTIVE:The aim of this prospective study was to evaluate the value of sinus echography results to directly indicate a transnasal puncture in intubated patients with suspicion of nosocomial maxillary sinusitis. DESIGN:prospective clinical investigation. SETTING:medical intensive care unit. PATIENTS:sixty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of maxillary sinusitis with purulent nasal discharge. INTERVENTIONS:120 sinuses were examined by sinus ultrasound. The image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: (1) a partial sinusogram was defined as the visualization of the hyperechogenic posterior wall of the sinus; and (2) a complete sinusogram was defined as the hyperechogenic visualization of posterior wall and the extension by the internal and external walls of the sinus. When sinus ultrasound was positive, a transnasal puncture was performed the same day. The transnasal puncture was positive if a fluid was obtained from sinus aspiration. The transnasal puncture was negative if there was no aspirated material. MEASUREMENTS AND RESULTS:sinus ultrasound was positive in 84 cases (54 complete sinusograms and 30 partial sinusograms). Seventy-eight of 84 transnasal punctures were positive. Sensitivity of a sinusogram for obtaining positive transnasal puncture was 100%, and specificity was 86% (100% in case of complete sinusogram) in a clinically selected population. The only six negative transnasal punctures were performed in patients with partial sinusogram. CONCLUSIONS:Ultrasound sinusitis evidence seems to be of value to indicate and perform a transnasal puncture directly, avoiding CT exam.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Vargas F,Bui HN,Boyer A,Bébear CM,Lacher-Fougére S,De-Barbeyrac BM,Salmi LR,Traissac L,Gbikpi-Benissan G,Gruson D,Hilbert G

doi

10.1007/s00134-006-0152-3

subject

Has Abstract

pub_date

2006-06-01 00:00:00

pages

858-66

issue

eissn

0342-4642

issn

1432-1238

journal_volume

pub_type

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Transnasal puncture based on echographic sinusitis evidence in mechanically ventilated patients with suspicion of nosocomial maxillary sinusitis.