Sinusitis in intensive care unit patients.

The ultimate source of sepsis may be difficult to pinpoint in critically ill patients with multiple possible sources of iatrogenic infection. In the last year, we have been consulted with regard to several febrile intensive care unit patients in whom sinusitis was initially identified by computerized axial tomography done for other reasons. The questions are: 1. are the x-ray findings significant; 2. is this the cause of fever and sepsis; 3. how should the patient be treated for this problem; and 4. can this be prevented. In five patients, sepsis was clearly related to sinusitis. Treatment had included nasal tubes in all six patients, and in addition, five patients had received high doses of corticosteroids while intubated. The sixth patient was a diabetic. Etiology, diagnosis, and management are discussed in detail. We believe that prolonged nasal intubation should be avoided, particularly in patients with decreased resistance to infection. Initial treatment consists of removing intranasal tubes and the administration of broad spectrum or culture specific antibiotics. Surgery is indicated in the event of persistent sepsis or secondary complications. Computerized tomography is an excellent tool for diagnosis and following response to therapy.