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Intubation Associated Sinusitis
Aka: Intubation Associated Sinusitis
- Risk Factors
- Nasotracheal Intubation (more than orotracheal intubation)
- Nasogastric Tubes (more than Orogastric Tubes)
- Orotracheal Intubation
- Causes
- Nosocomial Bacterial Sinusitis
- May be responsible for up to 40% of unexplained fever in Intensive Care patients
- Gram Negative Bacteria (e.g. Pseudomonas, Klebsiella) account for up to 50% of cases
- Gram Positive Bacteria (e.g. Streptococcus, Staphylococcus) account for another 35% of cases
- Invasive Fungal Sinusitis (immunocompromised patients)
- Rapidly progressive over hours
- Requires emergent surgical management
- Labs
- Gram Stain and Culture of sinus aspirate (by ENT)
- Nasal PCR for MRSA
- Imaging
- CT Sinus
- Sinus XRay has poor Test Specificity
- Most patients with 7 days of Nasogastric Tubes or nasotracheal tubes will have sinus fluid on XRay
- Fluid is sterile in nearly two thirds of those with xray findings
- Rouby (1994) Am J Respir Crit Care Med 150(3):776-83 +PMID: 8087352 [PubMed]
- Management
- General measures
- Consult Otolaryngology
- Intravenous Fluids (if Sepsis, follow guidelines)
- Empiric Antibiotics
- Imipenem (or Meropenem) or Ceftazidime (or Cefepime)
- Add Vancomycin if MRSA suspected (e.g. MRSA Nasal PCR or culture positive)
- Empiric Antifungal management (as indicated in immunocompromised patients)
- Suspected invasive fungal Sinusitis requires emergent otolaryngology Consultation
- Amphotericin B (covers Mucor and Aspergillus) AND
- Triazole such as posaconazole or isavuconazole (covers Scedosporium)
- References
- (2018) Sanford Guide, accessed on IOS 8/29/2018
- Zanten (2005) Crit Care 9(5): R583-R590 [PubMed]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297630/
- Joshua (2018) Ann Am Thorac Soc 15(6): 643-54 [PubMed]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207134/