Ventilator-associated sinusitis in adults: Systematic review and meta-analysis

Objective: To review the epidemiology, risk factors for, treatment and outcome of ventilator-associated sinusitis (VAS). Methods: We performed a systematic review and meta-analysis of available data without time restrictions. A conservative random effects model was employed to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs). Results: Out of 620 retrieved reports, 31 papers fulfilled our inclusion criteria. Infectious sinusitis affects 27% of mechanically ventilated patients and was found to be the cause of undetermined fever in 25% of the cases. Although radiographic VAS was higher in nasotracheally compared to orotracheally intubated patients (OR 4.66, 95% CI 1.35-16.13), clinical VAS was not (3.67, 0.80-6.81). The presence of VAS has been associated with the presence of VAP (3.66, 1.81-7.37) or bacteremia (6.85, 2.14, 21.92); however, it is unknown whether an etiologic relationship between them exists. In patients with concomitant VAS and VAP or bloodstream infections identical pathogens are isolated in 59% and 20% of the cases, respectively. The presence as opposed to absence of VAS was not associated with excess mortality (1.02, 0.35-3.01). Conclusion: VAS is a common infection in critically ill adults and correlates with other important infectious complications. (C) 2012 Elsevier Ltd. All rights reserved.