ULTRASONOGRAPHIC BEDSIDE EVALUATION OF MAXILLARY SINUS DISEASE IN MECHANICALLY VENTILATED PATIENTS

Objective:Evaluate A-mode ultrasonographic examination of maxillary si nus disease in mechanically ventilated, critically ill patients using sinoscopy as criterion standard. Design: Prospective case series. Sett ing: The intensive care units of a tertiary care hospital. Patients: 2 5 mechanically ventilated, critically ill patients with nasotracheal i ntubation of a tracheotomy were followed up by ultrasonographic examin ation of the maxillary sinuses in supine and semirecumbent positions. Infectious sinusitis was suspected in 15 patients, who were bilaterall y sinoscoped combined with sampling for bacterial culture. Results: Th e frequency of oedema and/or secretions was high: 29 antra of 30 exami ned. Only 2 of 30 antra showed bacterial infection. Ultrasonographic e xaminations were sensitive to general. pathological changes but less a ccurate in specific diagnostics such as the presence of secretions (se nsitivity for fluid 75 %, oedema 81 %). The sensitivity of ultrasonogr aphic diagnosis improved when the examination was made in the semirecu mbent position (sensitivity for fluid 91 %, oedema 81 %). Conclusions: A-mode ultrasonography is a useful method for daily use, being easy t o perform and without discomfort to the patient. It is fast and gives an immediate diagnosis. In intensive care unit patients, it should be the method of choice for day-today studies of effects and changes in t he upper airways. For the differential diagnosis of oedema and/or secr etions,it is not reliable enough to be used as the sole diagnostic met hod. A complementary investigation, such as computed tomography or sin oscopy, which also provides the opportunity to take samples, is needed for diagnostic confidence.