Intensive Care Medicine

, Volume 34, Issue 2, pp 264–270 | Cite as

Are daily routine chest radiographs useful in critically ill, mechanically ventilated patients? A randomized study

  • Christophe Clec’h
  • Paul Simon
  • Aïcha Hamdi
  • Lilia Hamza
  • Philippe Karoubi
  • Jean-Philippe Fosse
  • Frédéric Gonzalez
  • François Vincent
  • Yves Cohen
Original

Abstract

Objective

Whether chest radiographs (CXRs) in mechanically ventilated patients should be routinely obtained or only when an abnormality is anticipated remains debated. We aimed to compare the diagnostic, therapeutic and outcome efficacy of a restrictive prescription of CXRs with that of a routine prescription, focusing on delayed diagnoses and treatments potentially related to the restrictive prescription.

Design

Randomized controlled trial.

Setting

Intensive care unit of the Avicenne Teaching Hospital, Bobigny, France.

Patients and participants

All consecutive patients mechanically ventilated for ≥ 48 h between January and June 2006.

Interventions

Patients were randomly assigned to have daily routine CXRs (routine prescription group) or clinically indicated CXRs (restrictive prescription group).

Measurements and results

For each CXR, a questionnaire was completed addressing the reason for the CXR, the new findings, and any subsequent therapeutic intervention. The endpoints were the rates of new findings, the rates of new findings that prompted therapeutic intervention, the rate of delayed diagnoses, and mortality. Eighty-four patients were included in the routine prescription group and 81 in the restrictive prescription group. The rates of new findings and the rates of new findings that prompted therapeutic intervention in the restrictive prescription group and in the routine prescription group were 66% vs. 7.2% (p < 0.0001), and 56.4% vs. 5.5% (p < 0.0001) respectively. The rate of delayed diagnoses in the restrictive prescription group was 0.7%. Mortality was similar.

Conclusions

Restrictive use of CXRs in mechanically ventilated patients was associated with better diagnostic and therapeutic efficacies without impairing outcome.

Keywords

Intensive care Mechanical ventilation Routine chest radiographs Diagnosis Prognosis Efficacy 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Christophe Clec’h
    • 1
  • Paul Simon
    • 2
  • Aïcha Hamdi
    • 2
  • Lilia Hamza
    • 2
  • Philippe Karoubi
    • 2
  • Jean-Philippe Fosse
    • 2
  • Frédéric Gonzalez
    • 1
  • François Vincent
    • 2
  • Yves Cohen
    • 2
    • 3
  1. 1.Service de RéanimationHôpital Avicenne, Université Paris XIIIBobignyFrance
  2. 2.Service de RéanimationHôpital AvicenneBobigny CedexFrance
  3. 3.Service de RéanimationHôpital Avicenne, Université Paris XIII, EA 3409BobignyFrance

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