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

Author(s): Pneumatikos I, Konstantonis D, Tsagaris I, Theodorou V, Vretzakis G, Danielides V, Bouros D

Affiliation(s): Department of Intensive Care Unit, University Hospital of Alexandroupolis, 68100, Dragana, Greece, ipnevmat@med.duth.gr.

Publication date & source: 2006-04, Intensive Care Med., 32(4):532-7. Epub 2006 Feb 24.

Publication type:

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[Symbol: see text]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[Symbol: see text]mug budesonide (NDCA group, n[Symbol: see text]=[Symbol: see text]39) or placebo (control group, n[Symbol: see text]=[Symbol: see text]40). MEASUREMENTS: For the diagnosis of radiological maxillary sinusitis patients underwent paranasal computed tomography within 48[Symbol: see text]h of admission and thereafter every 4-7[Symbol: see text]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[Symbol: see text]=[Symbol: see text]21) but in 82% of controls (p[Symbol: see text]<[Symbol: see text]0.01), and infectious maxillary sinusitis in 8% of the NDCA group (n[Symbol: see text]=[Symbol: see text]3) but in 20% of controls (n[Symbol: see text]=[Symbol: see text]8; p[Symbol: see text]=[Symbol: see text]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.