Huyett Phillip, Raz Yael, Hirsch Barry E, McCall Andrew A
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Department of Otolaryngology-Head and Neck Surgery, Veteran's Affairs Hospital Pittsburgh, Pittsburgh, Pennsylvania.
Respir Care. 2017 Mar;62(3):350-356. doi: 10.4187/respcare.05172. Epub 2016 Dec 6.
This study was conducted to determine the incidence of and risk factors associated with the development of radiographic mastoid and middle ear effusions (ME/MEE) in ICU patients.
Head computed tomography or magnetic resonance images of 300 subjects admitted to the University of Pittsburgh Medical Center neurologic ICU from April 2013 through April 2014 were retrospectively reviewed. Images were reviewed for absent, partial, or complete opacification of the mastoid air cells and middle ear space. Exclusion criteria were temporal bone or facial fractures, transmastoid surgery, prior sinus or skull base surgery, history of sinonasal malignancy, ICU admission < 3 days or inadequate imaging.
At the time of admission, 3.7% of subjects had radiographic evidence of ME/MEE; 10.3% ( = 31) of subjects subsequently developed new or worsening ME/MEE during their ICU stay. ME/MEE was a late finding and was found to be most prevalent in subjects with a prolonged stay ( < .001). Variables associated with ME/MEE included younger age, the use of antibiotics, and development of radiographic sinus opacification. The proportion of subjects with ME/MEE was significantly higher in the presence of an endotracheal tube (22.7% vs 0.6%, < .001) or a nasogastric tube (21.4% vs 0.6%, < .001).
Radiographic ME/MEE was identified in 10.3% of ICU subjects and should be considered especially in patients with prolonged stay, presence of an endotracheal tube or nasogastric tube, and concomitant sinusitis. ME/MEE is a potential source of fever and sensory impairment that may contribute to delirium and perceived depressed consciousness in ICU patients.
本研究旨在确定重症监护病房（ICU）患者中耳乳突和中耳积液（ME/MEE）影像学表现的发生率及相关危险因素。
回顾性分析2013年4月至2014年4月入住匹兹堡大学医学中心神经科ICU的300例患者的头部计算机断层扫描或磁共振成像。观察乳突气房和中耳腔有无、部分或完全混浊。排除标准为颞骨或面部骨折、经乳突手术、既往鼻窦或颅底手术、鼻窦恶性肿瘤病史、ICU住院时间<3天或影像学检查不充分。
入院时，3.7%的患者有ME/MEE的影像学证据；10.3%（n = 31）的患者在ICU住院期间出现新的或加重的ME/MEE。ME/MEE是一种晚期表现，在住院时间延长的患者中最为常见（P <.001）。与ME/MEE相关的变量包括年龄较小、使用抗生素以及鼻窦影像学混浊的出现。气管插管（22.7%对0.6%，P <.001）或鼻胃管（21.4%对0.6%，P <.001）患者中ME/MEE的比例显著更高。
10.3%的ICU患者发现有ME/MEE影像学表现，对于住院时间延长、有气管插管或鼻胃管以及合并鼻窦炎的患者应特别考虑。ME/MEE是发热和感觉障碍的潜在来源，可能导致ICU患者出现谵妄和意识减退。
