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Occult fever in surgical intensive care unit patients is seldom caused by sinusitis
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the difference was due to the previous experience of the CABG patients in postoperative pulmonary toilet that improved their ability to handle the postoperative stress of the subsequent major surgery. The findings of this study are significant in that the authors not only failed to demonstrate increased risk in a group of patients who had previously undergone CABG surgery but in fact demonstrated a trend for an improved postoperative course. Decision-making regarding treatment options for patients requiring major surgery should not be based on the prior performance of CABG.
Occult Fever in Surgical Intensive Care Unit Patients Is Seldom Caused by Sinusitis. Karen R. Borman, Phillip M. Brown, Kimberly K. Mezera, Harish Jhaveri. Am J Surg 164:412-416, 1992 This report is a result of a prospective investigation involving nearly 600 intensive care unit (ICU) patients, of which 26 fulfilled the study requirements of nasal tube, ICU stay greater than 48 hours, and occult fever. These patients were studied using computed tomography (CT] and nearly three quarters (19) had abnormalities on scan. All 19 patients underwent antral puncture for diagnosis and culture and sensitivity. In all 19 patients, nasal tubes were removed. Antibiotics were administered at
the time of tube removal and antral puncture. Sinusitis was considered to be the definitive cause of fever only in the absence of another identifiable febrile source and “major” radiographic abnormalities including large air-fluid level or complete sinus opacification. Fever due to sinusitis could be clearly identified in only one patient (5%). The presence of a middle ear effusion correlated with the presence of a major radiologic abnormality in seven of eight patients who were examined. Antral punctures were positive in 15 of 19 patients with organisms recovered in 10 of 15.Half of the cultures were polymicrobial and over half grew gramnegative enteric bacilli. Infections in other sites were identified in 16 of 19 patients with radiographic abnormalities and fever resolved in 18 of 19 patients with radiographic abnormalities after therapy with decongestants, antibiotics, and nasal cannula removal. One patient developed subdural empyema and later succumbed to pneumonia. In conclusion, the authors note that at most only 16% of their group of patients could be construed as having fever due to sinusitis, and indeed on closer review they felt that fever due to sinusitis could be clearly demonstrated in only one patient who had extension beyond the sinus lumen. The authors effectively demonstrate that the majority of patients seen in an ICU with radiographic evidence of sinusitis do not have fever due to sinusitis.
the difference was due to the previous experience of the CABG patients in postoperative pulmonary toilet that improved their ability to handle the postoperative stress of the subsequent major surgery. The findings of this study are significant in that the authors not only failed to demonstrate increased risk in a group of patients who had previously undergone CABG surgery but in fact demonstrated a trend for an improved postoperative course. Decision-making regarding treatment options for patients requiring major surgery should not be based on the prior performance of CABG.
Occult Fever in Surgical Intensive Care Unit Patients Is Seldom Caused by Sinusitis. Karen R. Borman, Phillip M. Brown, Kimberly K. Mezera, Harish Jhaveri. Am J Surg 164:412-416, 1992 This report is a result of a prospective investigation involving nearly 600 intensive care unit (ICU) patients, of which 26 fulfilled the study requirements of nasal tube, ICU stay greater than 48 hours, and occult fever. These patients were studied using computed tomography (CT] and nearly three quarters (19) had abnormalities on scan. All 19 patients underwent antral puncture for diagnosis and culture and sensitivity. In all 19 patients, nasal tubes were removed. Antibiotics were administered at
the time of tube removal and antral puncture. Sinusitis was considered to be the definitive cause of fever only in the absence of another identifiable febrile source and “major” radiographic abnormalities including large air-fluid level or complete sinus opacification. Fever due to sinusitis could be clearly identified in only one patient (5%). The presence of a middle ear effusion correlated with the presence of a major radiologic abnormality in seven of eight patients who were examined. Antral punctures were positive in 15 of 19 patients with organisms recovered in 10 of 15.Half of the cultures were polymicrobial and over half grew gramnegative enteric bacilli. Infections in other sites were identified in 16 of 19 patients with radiographic abnormalities and fever resolved in 18 of 19 patients with radiographic abnormalities after therapy with decongestants, antibiotics, and nasal cannula removal. One patient developed subdural empyema and later succumbed to pneumonia. In conclusion, the authors note that at most only 16% of their group of patients could be construed as having fever due to sinusitis, and indeed on closer review they felt that fever due to sinusitis could be clearly demonstrated in only one patient who had extension beyond the sinus lumen. The authors effectively demonstrate that the majority of patients seen in an ICU with radiographic evidence of sinusitis do not have fever due to sinusitis.