The efficacy of functional endoscopic sinus surgery in the evolution of fever of unknown origin in ICU patients

Abstract

Conclusion: Functional endoscopic sinus surgery (FESS) was found to be effective in treating fever of unknown origin (FUO) in intensive care unit (ICU) patients with rhinosinusitis, with 62% of patients showing improvement within 5 days of the procedure. Objective: To correlate improvement in FUO with FESS drainage of the paranasal sinuses. Methods: Fifty patients that developed FUO during ICU stay, with CT findings suggestive of rhinosinusitis, and showed no improvement in fever after clinical treatment underwent FESS for drainage of the paranasal sinuses and were evaluated for postoperative improvement of fever. Results: The study sample consisted of 50 patients (74% of whom were male, mean age 48.1 years). The most frequent diagnoses at ICU admission were tetanus, pulmonary disease, and cardiovascular disease. In all, 68% of patients underwent nasogastric or enteral intubation. CT scanning most commonly showed involvement of the sphenoid sinus. In 54% of cases, sinusitis was bilateral and extended throughout the maxillary, ethmoidal, and sphenoidal sinuses. Sinusectomy was performed in all patients, and pathological secretion in the paranasal sinuses was seen in 52% of patients during surgery. Gram-negative bacteria were the most commonly isolated organisms, followed by Gram-positive bacteria and fungi. Improvement of fever was found in 82% of patients after FESS; 38% of these improved within the first 48 h post-procedure, and the remaining 62% within the first 5 postoperative days.

Keywords::

• Sinusitis
• surgery
• treatment
• diagnosis
• fever
• nosocomial infection
• microbiology
• nasal tubes

Acknowledgments

This study was developed by the Rhinology Group of the Otorhinolaryngology Division of the University of São Paulo Faculty of Medicine Clinics Hospital (HCFMUSP) and first presented at the Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum in Berlin, Germany, 24–27 August 2008. This study was supported by the State of São Paulo Research Foundation (FAPESP).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.