Clinical Study Of Sinusitis With Tracheal Intubation

Objective:To compare the incidence rate and outcome of sinusitis in patients who had undergone nasotracheal,orotracheal intubation and incision of trachea for mechanical ventilation.Methods:A total of 87 patients who had undergone mechanical ventilation for COPD, pulmonary interstitial fibrosis,severe pneumonia,bronchial asthma and coronary-artery bypass surgery were classified into three groups:the nasotracheal group,orotracheal group and incision of trachea group.The nasotracheal group also was separated according to the size of nasotracheal tubes:diameter 7.0 mm and diameter 7.5mm.Sinus computed tomography(CT) scans were performed before removing intubation,five days and ten days postoperatively.All patients had no history of previous sinusitis through radiographic evidence.Nasal discharge brush specimen,culture species,temperature,chest X-ray,and blood leucocytes were recorded.Results:The overall incidence rate of sinusitis in nasotracheal group and orotracheal group were 55.07%.Patients in nasotracheal group had higher incidence rate of sinusitis than that in orotracheal group(x~2=8.179,P＜0.01) and incision of trachea group(x~2=6.613,P＜0.05)respectively.Using nasotracheal tubes of 7.0mm diameter had a lower incidence rate of sinusitis than 7.5mm diameter(x~2=4.080,P＜0.05). Clinical evidences showed that mechanical ventilation associated sinusitis always happened in tubes inserted side of sinuses which most affected in maxillary sinus.Conclusion:The incidence rate of sinusitis in patients had undergone nasotracheal intubation was statistically significant higher than oral intubation and incision of trachea groups.Factors which may contribute to the development of sinusitis included the use of nasotracheal tubes of large diameter,traumatic intubation,blocking sinuses, prolonged of mechanical ventilation.There was no evidence showed that sinusitis could increase the occurrence of ventilator associated pneumonia.