Abstract
Objective
To study the accuracy of A-mode ultrasonography (A-MU) in detecting secretion in maxillary and frontal sinuses in critically ill, intubated patients undergoing mechanical ventilation.
Design
Open study in mechanically ventilated, comatose patients.
Setting
Medical-surgical intensive care unit in the General Hospital of Rovigo.
Patients
50 consecutive, mechanically ventilated, critically ill patients. All patients were in a coma and needed cerebral computed tomography (CT) for a diagnosis.
Measurements and results
The A-MU technique gave 100 images of maxillary and frontal sinuses. The images were read blindly and classified into five categories: definitely normal, definitely abnormal, probably normal, questionable, and probably abnormal. CT findings were considered to be the “gold standard”. The specificity of echo images varied from 72 to 98% and the sensitivity from 63 to 86% for maxillary sinuses. For frontal sinuses, the specificity varied from 96 to 99% and the sensitivity from 14 to 57%. The area under the receiver-operating characteristic curve was found to be 0.89 and 0.76 for maxillary and frontal sinuses, respectively.
Conclusions
The A-MU technique is an accurate tool for detecting secretion in the maxillary sinuses in intubated patients. More investigations are necessary in order to evaluate its usefulness in the frontal sinuses.
References
Borman KR, Brown PM, Mezera KK, Jhaveri H (1992) Occult fever in surgical intensive care unit patients is seldom caused by sinusitis. Am J Surg 164:412–415
Aebert H, Hunefeld G, Regel G (1988) Paranasal sinusitis and sepsis in ICU patients with nasotracheal intubation. Intensive Care Med 15:27–30
Deutschman CS, Wilton P, Sinow J, Dibbell D, Konstantinides FN, Cerra FB (1986) Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis. Crit Care Med 14:111–114
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections. Am J Infect Control 16:128–140
Carter BL, Bankoff MS, Fisk JD (1983) Computed tomographic detection of sinusitis responsible for intracranial and extracranial infections. Radiology 147:739–742
Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977
Revonta M (1980) Ultrasound in diagnosis of maxillary and frontal sinusitis. Acta Otoloryngol Suppl (Stockh) 370:1–55
Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36
Jannert M, Andreasson L, Holmer NG, Liorinc P (1982) Ultrasonic examination of the paranasal sinuses. Acta Otolaryngol Suppl 389:1–52
Mann W, Beck C, Apostolidis T (1977) Liability of ultrasound in maxillary sinus disease. Arch Oto Rhino Laryngol 215:67–74
Shapiro GG, Furukawa CT, Pierson WE, Gilbertson E, Bierman CW (1986) Blinded comparison of maxillary sinus radiography and ultrasound for diagnosis of sinusitis. J Allergy Clin Immunol 77:59–64
Rohr AS, Spector SL, Siegel SC, Katz RM, Rachelefsky GS (1986) Correlation between A-mode ultrasound and radiography in the diagnosis of maxillary sinusitis. J Allergy Clin Immunol 78:58–61
Salord F, Gaussorgues P, Marti-Flich J, Sirodot M, Allimant C, Lyonnet D, Robert D (1990) Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation. Intensive Care Med 16:390–393
Rouby JL, Laurent P, Gosnach M, Cambau E, Lamas G, Zouaoui A, Leguillou JL, Bodin L, Khac TD, Marsault C, Poète P, Nicolas MH, Jarlier V, Viars P (1994) Risk factors and clinical relevance of nosocomial maxillary sinusitis in the critically ill. Am J Resp Crit Care Med 150:776–783
Author information
Authors and Affiliations
Additional information
The work was done at the General Hospital, Rovigo, Italy
Rights and permissions
About this article
Cite this article
Lucchin, F., Cordella, L., Palù, M. et al. Comparison of A-mode ultrasound and computed tomography: Detection of secretion in maxillary and frontal sinuses in ventilated patients. Intensive Care Med 22, 1265–1268 (1996). https://doi.org/10.1007/BF01709347
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01709347