Articles: intubation.
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During a 24-month period, 34 cases of nosocomial sinusitis associated with nasopharyngeal instrumentation were identified in 32 severely traumatized patients, accounting for 5% of all nosocomial infections. Diagnosis was based on roentgenographic findings consistent with acute sinusitis and either purulent material aspirated from the involved sinus or purulent nasal discharge. All patients had fever and most had leukocytosis. ⋯ Seven, although asymptomatic, had persistent radiological abnormalities consistent with chronic sinusitis. Five patients died of intercurrent disease before resolution of their sinusitis. Sinusitis should be ruled out as a cause of infection in febrile intensive care patients with an indwelling nasal tube.
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Management of the airway in acute epiglottitis is still controversial. One argument against intubation as opposed to tracheostomy is the increased complications from prolonged intubation. ⋯ Included in this series are 16 consecutive patients who were treated by nasotracheal intubation and simultaneous medical therapy. Fifteen of the 16 patients extubated safely in less than 48 hours, significantly decreasing the possibility for complications.