儿科重症监护病房的偶发性鼻窦炎。

Incidental sinusitis in a pediatric intensive care unit.

机构信息

Division of Pediatric Pulmonology, Department of Pediatrics, University of Minnesota School of Medicine and Amplatz Children's Hospital, Minneapolis, MN, USA.

出版信息

Pediatr Crit Care Med. 2012 Mar;13(2):e64-8. doi: 10.1097/PCC.0b013e31820ac3f5.

DOI:10.1097/PCC.0b013e31820ac3f5

PMID:21283043

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3856864/

Abstract

OBJECTIVE

Intubation is a risk factor for nosocomial sinusitis in adult intensive care patients. Sinusitis in intubated adults can be an occult cause of fever. In children, nasal intubation may increase the risk of sinusitis. No pediatric study has determined the frequency of nosocomial sinusitis in the pediatric intensive care unit setting. We hypothesized that within a subset of patients who had head computed tomography imaging 1) the incidental frequency of sinusitis in pediatric intensive care unit patients exceeds the frequency in non-pediatric intensive care unit patients, 2) the frequency of sinusitis is greater in pediatric intensive care unit patients with a tube (nasotracheal, nasogastric, orotracheal, or orogastric) compared to those without a tube, and 3) nasal tubes confer an increased risk for sinusitis over oral tubes.

DESIGN

Retrospective chart review.

SETTING

Independent not-for-profit pediatric healthcare system.

PATIENTS

Pediatric intensive care unit and non-pediatric intensive care unit (inpatients hospitalized on medical-surgical wards) patients referred for head computed tomography.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Computed tomography images were scored using the Lund-MacKay staging system. Sinusitis was defined as a Lund-MacKay score ≥5. A total of 596 patients were studied, 395 (66.3%) in the pediatric intensive care unit. A total of 154 (44.3%) pediatric intensive care unit vs. 54 (26.9%) non-pediatric intensive care unit patients had sinusitis (p < .001). A total of 102 of 147 (69.4%) pediatric intensive care unit patients with a tube present had sinusitis vs. 73 of 248 (29.4%) patients without a tube present (p < .001). There was no difference in sinusitis based on tube location (p = .472). Of patients with sinusitis, 51.3% (81 of 158) compared to 39.4% (89 of 226) were febrile within 48 hrs of imaging (p = .021). A younger age or the presence of a tube increased the probability of sinusitis (p < .001).

CONCLUSIONS

A total of 44.3% of our pediatric intensive care unit patients imaged for reasons other than evaluation for sinus disease had evidence of sinusitis, and 51.3% of these had fever. These findings raise the concern that sinusitis in pediatric intensive care unit patients is common and should be considered in the differential diagnosis of fever in pediatric intensive care unit patients.

摘要

目的

气管插管是成人重症监护病房发生医院获得性鼻窦炎的一个危险因素。气管插管的成年人鼻窦炎可能是发热的隐匿原因。在儿童中，鼻插管可能会增加鼻窦炎的风险。没有儿科研究确定儿科重症监护病房环境中医院获得性鼻窦炎的频率。我们假设，在接受头部计算机断层扫描成像的患者亚组中：1）儿科重症监护病房患者的鼻窦炎偶发率超过非儿科重症监护病房患者；2）与无管患者相比，有管（经鼻、经胃、经口或经口胃）的儿科重症监护病房患者的鼻窦炎发生率更高；3）与经口管相比，经鼻管增加了鼻窦炎的风险。

设计

回顾性图表审查。

设置

独立的非营利性儿科医疗保健系统。

患者

儿科重症监护病房和非儿科重症监护病房（住院于内科-外科病房的患者）患者，因头部计算机断层扫描而转介。

干预措施

无。

测量和主要结果

使用 Lund-MacKay 分期系统对计算机断层扫描图像进行评分。鼻窦炎的定义为 Lund-MacKay 评分≥5。共研究了 596 例患者，其中 395 例（66.3%）在儿科重症监护病房。儿科重症监护病房共有 154 例（44.3%）患者发生鼻窦炎，而非儿科重症监护病房 54 例（26.9%）患者发生鼻窦炎（p<0.001）。在存在管的 147 例儿科重症监护病房患者中，有 102 例（69.4%）发生鼻窦炎，而在无管的 248 例患者中，有 73 例（29.4%）发生鼻窦炎（p<0.001）。根据管的位置，鼻窦炎无差异（p=0.472）。在患有鼻窦炎的患者中，51.3%（81/158）在成像后 48 小时内发热，而 39.4%（89/226）未发热（p=0.021）。年龄较小或存在管会增加鼻窦炎的可能性（p<0.001）。