Professional Documents
Culture Documents
Efficacy of Chest Radiography Ina Respiratory Intensive Care Unit
Efficacy of Chest Radiography Ina Respiratory Intensive Care Unit
Efficacy of Chest Radiography Ina Respiratory Intensive Care Unit
A prospective study of chest radiographic examinations in a examinations that were prompted by a change in a patients
respiratory intensive care unit was conducted to determine clinical status. Less than 6 percent ofthe radiographic films
the diagnostic and therapeutic efficacy of such examina- taken post-procedure demonstrated abnormalities poten-
tions. Analysis of data from 1,354 x-ray films from 167 tially related to the procedure. We conclude that, in a
patients revealed a 34.5 percent incidence of new (or respiratory intensive care unit: 1) routine morning radio-
increased) abnormalities, or tube or catheter malposition. graphic examination frequently demonstrates unexpected
Changes in diagnostic approach or therapeutic measures, or changing abnormalities, many of which prompt changes
excluding catheter position adjustments, occurred after 28.5 in diagnosis or management; 2) radiographic evaluation of a
percent ofthe examinations. Radiographic yield was higher change in a patients clinical condition has a higher yield
when a change in clinical condition prompted the radio- than routine examinations; and 3) post-procedure radio-
graphic examination than when the examination was a graphic examination uncommonly demonstrates complica-
routine morning study. Changes in the approach to patient tions related to the procedure, but frequently demonstrates
management were also more likely (42.7 percent) following abnormalities of tube or catheter placement.
or the influence of a test result on diagnosis; 2) entered data on the technical adequacy ofthe radiographic film, the
position of the patient at the time of the examination; the level of
therapeutic efficacy, or the effect of a test result on
positive end-expiratory pressure, if applicable; the position of all
clinical management; and 3) outcome efficacy, or the visible tubes and catheters, including thoracostomy tubes, pulmo-
effect that a test result will have on patient outcome. In nary artery catheters, endotracheal tubes, central venous catheters,
this prospective study, we analyzed the occurrence of and nasogastric and small bowel tubes. The fellow also entered
new or increased radiographic abnormalities, as well as information about all pathologic findings and a comment as to
whether the abnormality was new, increased, decreased, or un-
the specific actions taken as a result ofthe information
changed. Finally, the fellow entered information regarding whether
obtained from such radiographic examinations of the the finding elicited a diagnostic or therapeutic response and what
chest, in a respiratory intensive care unit, thus yielding that response was. Diagnostic actions available for selection on the
information about the first two types ofefficacy, but not computer included institution of hemodynamic monitoring, thora-
The Intermountain Respiratory Intensive Care Unit (IRICU) at and other therapy changes. Certain subgroups ofradiographic films,
LDS Hospital is a three-bed primary and referral facility staffed with to be described later, were examined by one of us (WB), and the
onsite residents and pulmonary fellows and oncall pulmonary findings were found to closely match the responses recorded in the
intensivists. The IRICU is designed to treat patients in whom the computerized data entries. The computer data was also examined to
primary threat to life is respiratory or ventilatory failure. The most confirm that findings reported to be new had not been recorded as
frequent clinical problems encountered in this setting include adult present on the two previous radiographic films. Statistical analysis of
respiratory distress syndrome, pneumonia, pulmonary embolism, the potential differences between groups were performed using the
chronic obstructive pulmonary disease with superimposed acute proportionality test.9
respiratory failure, asthma, and aspiration pneumonitis. Prior to any
radiographic exposure in the IRICU, electrocardiographic leads and RESULTS