Method of treatment of nosocomial sinusitis in patients of intensive care units
Abstract
Abstract.
The clinical significance of nosocomial sinusitis (NS) is in its association with an increase in infectious complications such as ventilator-associated pneumonia (VAP), sinus thrombosis, sepsis, etc. Due to the difficult outflow of the contents of the paranasal sinuses and high antibiotic resistance of NS pathogens, the use of local treatment methods such as drainage is rather relevant.
Objectives. To develop an effective method for drainage of the maxillary sinuses (MS) in NS for patients of the intensive care unit (ICU).
Material and methods. An open, prospective, non-randomized study was performed. Patients were in the ICU and divided into 2 groups: Group 1 – 28 patients with NS on the mechanical ventilation (MV) and treated according to the method we have developed; Group 2 – 26 patients, in whom the treatment of NS was carried out by the standard method – the maxillary sinus puncture.
Results. While comparing two groups, significantly lower total time was established for the sanitation of the maxillary sinus (number of procedures n=2) in patients of group 1 (pMann–Whitney U test<0.05). Also, during repeated manipulations for the sanitation of the maxillary sinus in patients of group 1, there was no pain reaction from the procedure and there was no need to use local anesthetics. Nasal bleeding from during manipulations in patients of group 1 was observed in 2 cases, while in group 2 – in 8 cases respectively.
Conclusions. The developed method of maxillary sinus drainage, which includes the installation of a double-lumen catheter into the maxillary sinus cavity with subsequent daily rinsing of the sinus with 0.05% chlorhexidine bigluconate solution, is more effective and safer both in terms of time spent on the procedure (pMann–Whitney U test<0.05) and the number of bleedings (p=0.0255), compared to the standard method of the maxillary sinus puncture.
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