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A postural change test improves the prediction of a radiological maxillary sinusitis by ultrasonography in mechanically ventilated patients.

Abstract : OBJECTIVE: The aim of this study was to evaluate a postural change test during sinus ultrasound, compared with CT scan, in case of partial sinusogram to differentiate air-fluid level from mucosal thickening. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit. PATIENTS: 150 intubated patients. INTERVENTIONS: Patients were examined by sinus ultrasound in half-sitting position. A partial sinusogram was defined as the sole visualization of the hyperechogenic posterior wall of the sinus. In this situation, a postural change was performed and ultrasound was achieved in supine position. If the partial sinusogram disappeared when the patient was placed in a supine position (positive test), the partial sinusogram was an air-fluid level. If the partial sinusogram did not disappear (negative test), we considered it as a mucosal thickening. The CT and ultrasound were performed on the same day. Radiological maxillary sinusitis (RMS) on CT was defined as the presence of an air-fluid level. Absence of RMS on CT was defined as normal sinus or as the presence of mucosal thickening. MEASUREMENTS AND RESULTS: 300 sinuses were examined. A partial sinusogram was found in 90 sinuses and CT scan confirmed the presence of RMS in 55 sinuses (61%). Sensitivity, specificity, positive predictive value, and negative predictive value of postural change test compared with CT were, respectively, 94.6, 85.6, 91.2 and 90.9%. The positive predictive value increased from 61 to 91.2% after the postural change test. CONCLUSIONS: In case of a partial sinusogram, a postural change increases the accuracy of ultrasound to diagnose RMS.
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https://www.hal.inserm.fr/inserm-00168571
Contributor : Evelyne Mouillet <>
Submitted on : Wednesday, August 29, 2007 - 10:30:06 AM
Last modification on : Wednesday, November 29, 2017 - 2:54:35 PM

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Frédéric Vargas, Alexandre Boyer, Hoang Nam Bui, Louis Salmi, Didier Gruson, et al.. A postural change test improves the prediction of a radiological maxillary sinusitis by ultrasonography in mechanically ventilated patients.. Intensive Care Medicine, Springer Verlag, 2007, 33 (8), pp.1474-8. ⟨10.1007/s00134-007-0726-8⟩. ⟨inserm-00168571⟩

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