The Routine Daily CXR
14/10/10
- controversial issue
- viewed as an essential tool but is subject to overuse and misinterpretation
- evidence to support or refute practice is sparse
- hard to study due to: investigator bias, blinding problems and outcome assessment
- generalisability is an issue (North America and Europe - single speciality ICU vs Australiasian
ICU – MDT based, closed units)
-> American College of Radiology statement = that mechanically ventilated patient should
have a daily routine CXR
Indications
- any ventilated patient with a sudden respiratory or cardiovascular deterioration
- post line/tube insertion (NG, ETT, CVL, PAC, ICD, pacing wire)
Method
- erect preferred
- consistent distance and energy level
- in full inspiration (hold during exposure ideal but no always practical)
Precautions
- pregnancy
- over reproductive organs in young patients
- staff to stay > 3m away from xrays
Information
-
position of hardware
heart
mediastinum
soft tissue
bone
lung
trends/changes
Advantages
- hardward placement confirmation (lines, tubes, pipes, wires)
- detection of expected/unexpected disease progression and complications
- assessment of hypervolaemia, new infiltrates, pleural complications
Disadvantages
Jeremy Fernando (2010)
- radiation exposure (staff and patients)
- potential for lines/tube displacement
- cost
- false positives/negative findings
- evidence does not suggest that daily routine CXR leads to changes in therapeutic decision
making
- length of stay and duration of MV not adversely affected by elimination of routine daily CXR
Jeremy Fernando (2010)