Critically evaluate the clinical value of daily routine chest radiographs in the ICU.
Daily “routine” CXR in (usually) intubated patients: controversial-evidence to support or refute practice, hard to study due to investigator bias, blinding problems and outcome assessment.
Generalisability may be an issue from often single specialty North American or European units to the usual multidisciplinary Australasian ICU. The consensus opinion of the Am. College of radiology is that daily routine CXR are indicated in patients who are mechanically ventilated . The evidence to date does not suggest that daily routine CXRs lead to changes in therapeutic decision making. Data suggest that length of stay and duration of mechanical ventilation are not adversely affected by elimination of daily routine CXR.
a) Confirmation of placement of major lines / tubes / pipes / wires
detects expected/unexpected disease progression/complications requiring treatment
b) Reasonable assessment of hypervolaemia/LVF, new infiltrates accompanying fever, pleural complications, endotracheal tube displacement
radiation exposure-staff/patients potential for line/tube displacement Cost
False positive/false negative findings
Rationale for routine CXRs:
Evidence and recommendations:
Ganapathy, Anusoumya, et al. "Routine chest x-rays in intensive care units: a systematic review and meta-analysis." Crit Care 16.2 (2012): R68.
Amorosa, Judith K., et al. "ACR appropriateness criteria routine chest radiographs in intensive care unit patients." Journal of the American College of Radiology 10.3 (2013): 170-174.
Veličković, Jelena, et al. "Routine chest radiographs in the surgical intensive care unit: Can we change clinical habits with no proven benefit?." Acta chirurgica iugoslavica 60.3 (2013): 39-44.
Cruz, Jeffrey, et al. "Evaluation of the Clinical Utility of Routine Daily Chest Radiography in Intensive Care Unit Patients With Tracheostomy Tubes A Retrospective Review." Journal of intensive care medicine (2014): 0885066614538393.