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Complicações de sinusite aguda numa unidade de cuidados intensivos pediátricos : estudo dos últimos 10 anos
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Introdução: A sinusite é uma patologia comum em Pediatria. A maioria dos casos tem um curso benigno, mas 3 a 5% têm complicações graves com necessidade de internamento em unidade de cuidados intensivos (UCIP). O objetivo deste estudo foi a caracterização dos internamentos por complicações de sinusite numa UCIP.
Material e Métodos: Estudo retrospetivo descritivo com consulta de processos clínicos dos doentes internados na UCIP do Hospital de Santa Maria-CHULN por complicações de sinusite, de 01/01/2009 a 31/12/2018. Foram analisados dados demográficos, clínicos, laboratoriais e imagiológicos.
Resultados: Durante este período foram internados 18 doentes, 66.7% sexo masculino, mediana de idades de 11 anos e 10 meses (3M – 14A e 8M). A complicação mais frequente foi empiema subdural (14), celulite pré-septal (4), celulite pós-septal (3), meningite (3), trombose dos seios venosos (3), AVC isquémico (2), abcesso orbitário (2), choque séptico (1), choque tóxico (1), meningoencefalite (1), vasculite (1) e osteomielite (1). À admissão, 10 doentes tiveram convulsões, 10 apresentavam hipertensão intracraniana, dois tinham choque ; sete necessitaram de ventilação invasiva, um de suporte vasoativo. Todos os doentes iniciaram terapêutica antibiótica empírica com uma associação de pelo menos dois fármacos de classes diferentes, todos os esquemas tinham pelo menos um betalactâmico. Onze empiemas foram drenados cirurgicamente, dois doentes fizeram craniectomia descompressiva; em 12 doentes houve intervenção pela ORL. Dos microorganismos isolados a maioria era aeróbios Gram+, em 6 doentes isolou-se um anaeróbio facultativo. À data de alta nove doentes apresentavam défices focais, com recuperação total em cinco casos; três mantiveram terapêutica anticonvulsivante durante o seguimento. Não se registaram óbitos.
Conclusões: A complicação mais frequente foi o empiema subdural, por agentes Gram +. Apesar da gravidade inicial e de algumas lesões sequelares, a evolução foi favorável. A abordagem cirúrgica precoce associada a um tratamento médico agressivo são a terapêutica de eleição nestes doentes.
Introduction: Sinusitis is a common disease in the paediatrics population. Most of the cases have a benign evolution, however 3 to 5% of the patients may have severe complications that require critical care support in a Paediatric Intensive Care Unit (PICU). This study aims to describe the hospitalizations from complicated sinusitis in a PICU. Methods: Retrospective, descriptive study based on the review of the medical records of children admitted to the PICU of Hospital de Santa Maria – CHULN due to complicated sinusitis, from 01/01/2009 to 31/12/2018. We analysed demographic, clinical, laboratorial and imagilogical data. Results: During this period 18 patients were admitted, 66.7% male, with a median age of 11 years and 10 months (3M – 14A e 8M). The most common complication was subdural empyema (14), followed by pre-septal cellulitis (4), post-septal cellulitis (3), meningitis (3), venous sinus thrombosis (3), ischemic stroke (2), orbital abscess (2), septic shock (1), toxic shock (1), meningoencephalitis (1), vasculitis (1) and osteomyelitis (1). On initial presentation 10 patients had seizures, 10 had intracranial hypertension and two patients were hemodynamically unstable (one with septic shock, the other with toxic shock). Seven patients needed mechanical ventilation and one started vasoactive support. Empirical antibiotic treatment was prescribed to all cases, associating two antibiotics of different classes (one of them was a beta-lactam). Twelve empyema were surgically drained, two patients needed a decompressive craniotomy and 12 had Otorhinolaryngology intervention. Gram + agents were the most frequently identified and in six patients it was isolated a facultative anaerobe. At discharge nine patients had focal deficits, with a total recovery in five; at present time three are still on anticonvulsive therapy. There were no deaths. Conclusions: The most common complication was subdural empyema, by Gram + bacteria. Despite of the initial severity and some sequelae, the overall evolution was favourable. Treatment relies on early surgical approach and aggressive medical therapy.
Introduction: Sinusitis is a common disease in the paediatrics population. Most of the cases have a benign evolution, however 3 to 5% of the patients may have severe complications that require critical care support in a Paediatric Intensive Care Unit (PICU). This study aims to describe the hospitalizations from complicated sinusitis in a PICU. Methods: Retrospective, descriptive study based on the review of the medical records of children admitted to the PICU of Hospital de Santa Maria – CHULN due to complicated sinusitis, from 01/01/2009 to 31/12/2018. We analysed demographic, clinical, laboratorial and imagilogical data. Results: During this period 18 patients were admitted, 66.7% male, with a median age of 11 years and 10 months (3M – 14A e 8M). The most common complication was subdural empyema (14), followed by pre-septal cellulitis (4), post-septal cellulitis (3), meningitis (3), venous sinus thrombosis (3), ischemic stroke (2), orbital abscess (2), septic shock (1), toxic shock (1), meningoencephalitis (1), vasculitis (1) and osteomyelitis (1). On initial presentation 10 patients had seizures, 10 had intracranial hypertension and two patients were hemodynamically unstable (one with septic shock, the other with toxic shock). Seven patients needed mechanical ventilation and one started vasoactive support. Empirical antibiotic treatment was prescribed to all cases, associating two antibiotics of different classes (one of them was a beta-lactam). Twelve empyema were surgically drained, two patients needed a decompressive craniotomy and 12 had Otorhinolaryngology intervention. Gram + agents were the most frequently identified and in six patients it was isolated a facultative anaerobe. At discharge nine patients had focal deficits, with a total recovery in five; at present time three are still on anticonvulsive therapy. There were no deaths. Conclusions: The most common complication was subdural empyema, by Gram + bacteria. Despite of the initial severity and some sequelae, the overall evolution was favourable. Treatment relies on early surgical approach and aggressive medical therapy.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Sinusite Complicações Unidade de cuidados intensivos Pediatria