Chest
Clinical Investigations in Critical CareUtility of Daily Routine Portable Chest Radiographs in Mechanically Ventilated Patients in the Medical ICU
Section snippets
Procedure and Data Collection
We prospectively evaluated patients who had been admitted to the 20-bed medical ICU of the Beth Israel Deaconess Medical Center in Boston, MA, over a 10-month period in 1999 to 2000, at which time there was no set policy regarding daily vs clinically indicated CXRs. Practice varied depending on the beliefs and biases of the individual faculty member who was serving as the ICU attending physician for a given month. Our closed medical ICU is staffed 24 h per day with medical house staff who are
Evaluation of Population Groups
We evaluated 94 patients over a 10-month period (Fig 1). A total of 293 CXRs were obtained from 43 patients in the routine arm of the study. These included 200 daily routine CXRs and 93 CXRs that were obtained as a result of a specific clinical indication. In the nonroutine arm of the study, there were 226 CXRs that were acquired from 51 patients. We enrolled a seemingly low number of patients in our study because the entry criteria did not allow all individuals with respiratory failure to be
Discussion
We have shown that a strategy that called for only nonroutine (ie, clinically indicated) CXRs did not differ from one that required routine (ie, daily) CXRs in terms of diagnostic and therapeutic efficacy when applied to patients receiving mechanical ventilation in a medical ICU. In evaluating outcome efficacy, we also showed that the patients from whom only nonroutine CXRs were obtained did as well from a clinical perspective as the patients from whom routine CXRs were obtained. Furthermore,
ACKNOWLEDGMENT
We are indebted to Sara Yankelev, MPH, of Abt Associates Clinical Trials, Cambridge, MA, for assistance in the statistical analyses. We express our appreciation to the nursing staff of the medical ICU for their assistance during the study. Finally, we extend our gratitude to the medical house staff of the Beth Israel Deaconess Medical Center, who were instrumental in data acquisition.
References (8)
- et al.
Efficacy of chest radiography in a respiratory intensive care unit: a prospective study
Chest
(1985) - et al.
Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position
Chest
(1989) - et al.
Efficacy of daily routine chest radiographs in intubated, mechanically ventilated patients
Crit Care Med
(1991) - et al.
The utility of routine daily chest: radiography in the surgical intensive care unit
J Trauma
(1993)
Cited by (88)
REDUCE – Indication catalogue based ordering of chest radiographs in intensive care units
2022, Journal of Critical Care“Rule Out” vs “Do Without”
2021, ChestThe Value of Supine Chest X-Ray in the Diagnosis of Pneumonia in the Basal Lung Zones
2018, Academic RadiologyReducing Portable Chest Radiography in the Intensive Care Unit
2017, Journal of the American College of RadiologyClinical relevance of the routine daily chest X-Ray in the surgical intensive care unit
2017, American Journal of SurgeryCitation Excerpt :Overall, we found no differences in outcomes, including mortality, complications, LOS or requirement for mechanical ventilation. These findings are in line with multiple other studies including the largest meta-analysis performed on this topic.1–3,9,10,13–16,19 This meta-analysis analyzed 9 studies with a combined total of 39,358 CXRs for 9611 patients and found no difference in ICU or hospital mortality, ICU or overall LOS or duration of mechanical ventilation.10
High-value care in the surgical intensive care unit: Effect on ancillary resources
2016, Journal of Surgical Research