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

• Published in: Intensive care medicine 2006-06, Vol.32 (6), p.858-866
• Main Authors: VARGAS, Frédéric, BUI, Hoang Nam, HILBERT, Gilles, BOYER, Alexandre, BEBEAR, Cécile Marie, LACHER-FOUGERE, Stéphane, DE-BARBEYRAC, Bertillle Marie, SALMI, Louis Rachid, TRAISSAC, Louis, GBIKPI-BENISSAN, Georges, GRUSON, Didier
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Artificial respiration; Biological and medical sciences; Care and treatment; Causes of; Clinical death. Palliative care. Organ gift and preservation; Cross Infection; Diagnosis; Emergency and intensive respiratory care; Female; France; Humans; Hypotheses; Intensive care; Intensive care medicine; Intubation; Male; Medical sciences; Middle Aged; Paranasal Sinuses - diagnostic imaging; Patients; Prospective Studies; Punctures - adverse effects; Respiration, Artificial - adverse effects; Sinuses; Sinusitis; Sinusitis - etiology; Sinusitis - physiopathology; Ultrasonic imaging; Ultrasonography; Ultrasound imaging; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-006-0152-3

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. prospective clinical investigation. medical intensive care unit. sixty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of maxillary sinusitis with purulent nasal discharge. 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. 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. Ultrasound sinusitis evidence seems to be of value to indicate and perform a transnasal puncture directly, avoiding CT exam.