1 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Intensive Care Med. 2019 Oct;34(10):844-850. doi: 10.1177/0885066617718458. Epub 2017 Jul 4.
The association between intensive care unit (ICU) sinusitis and the development of lower airway infections remains unclear. The objective of this study was to determine the correlation between the development of radiographic sinus opacification and pneumonia in the neurologic ICU setting.
A retrospective review of head computed tomography or magnetic resonance imaging of 612 patients admitted to the neurocritical care unit at a tertiary care center from April 2013 through April 2014 was performed. Paranasal sinus opacification was measured using Lund-Mackay scores (LMS). A diagnosis of pneumonia was determined by the ICU team from radiographic, laboratory, and pulmonary data. Exclusion criteria included a history of endonasal surgery, sinonasal malignancy, facial fractures, ICU admission less than 3 days, or inadequate imaging.
Worsening sinus opacification occurred in 42.6% of patients and pneumonia in 18.5% of patients during ICU admission. Of the patients who developed pneumonia, 71.7% also developed worsening sinus opacification ( < .001). In 80.2% of cases, the sinus opacification developed prior to the diagnosis of pneumonia. The mean highest LMS for patients who developed pneumonia was 4.24 compared to 1.99 in patients who did not develop pneumonia ( < .001). Sinus air-fluid levels or complete sinus opacification occurred in a larger proportion of patients who developed pneumonia (46.9% vs 19.4%, < .001). Mortality rates for patients with no pneumonia or sinusitis, pneumonia only, sinusitis only, and sinusitis with pneumonia were 7.6%, 15.6%, 18.3%, and 25.9%, respectively ( < .001).
This study finds a strong relationship between worsening sinus opacification in the neurologic ICU patient to the development of hospital-acquired pneumonia and increased mortality.
重症监护病房（ICU）鼻窦炎与下呼吸道感染的发展之间的关系尚不清楚。本研究的目的是确定神经重症监护病房（NICU）患者放射影像学鼻窦混浊与肺炎之间的相关性。
对 2013 年 4 月至 2014 年 4 月在一家三级医疗中心的神经危重病护理单元收治的 612 例患者的头颅 CT 或磁共振成像进行回顾性审查。使用 Lund-Mackay 评分（LMS）测量副鼻窦混浊程度。肺炎的诊断由 ICU 团队根据影像学、实验室和肺部数据确定。排除标准包括鼻内手术史、鼻窦恶性肿瘤、面部骨折、入住 ICU 少于 3 天或影像检查不充分。
在 ICU 住院期间，42.6%的患者鼻窦混浊程度加重，18.5%的患者发生肺炎。在发生肺炎的患者中，71.7%的患者同时出现鼻窦混浊程度加重（<0.001）。在 80.2%的情况下，鼻窦混浊发生在肺炎诊断之前。发生肺炎的患者的最高平均 LMS 为 4.24，而未发生肺炎的患者为 1.99（<0.001）。发生肺炎的患者中鼻窦气液平面或完全鼻窦混浊的比例较大（46.9%比 19.4%，<0.001）。无肺炎或鼻窦炎、仅肺炎、仅鼻窦炎和鼻窦炎伴肺炎的患者死亡率分别为 7.6%、15.6%、18.3%和 25.9%（<0.001）。
本研究发现，神经重症监护病房患者鼻窦混浊程度加重与医院获得性肺炎的发生和死亡率增加之间存在密切关系。
