ELECTRONIC SUPPLEMENTARY MATERIAL ESM 1: Case report form FOR EACH CXR on RadioDay This case report form have to be filled on the day after (or two days after) the RadioDay. NAME of the patient (3 1st letters): ----------------------------------------------------------------|___||___||___|1. FIRST NAME (2 1e letters) : ---------------------------------------------------------------------------------|___||___|2. Gender : ---------------------------------------------------------- M □ F □ 3. Weight -- |___||___||___| Kg 4. Height -- |___||___||___| cm 5. DATE of BIRTH : ------------------------------------------------|___||___| / |___||___| / |___||___||___||___| 6. DATE of ICU admission : -------------------------------------|___||___| / |___||___| / |___||___||___||___ |7. REASON FOR ICU ADMISSION : □Medical 8. □General surgery □Cardiopulmonary surgery □Neurosurgery □Other Multidrug resistant bacteria requiring the isolation of the patient at the time of the CXR ? Yes □ No □ 9. SOFA score on RadioDay Points 1 2 3 4 PaO2 / FiO2 (mmHg / 0,xx) < 400 < 300 < 200 with MV < 100 with MV Platelets (103 / mm3) < 150 < 100 < 50 < 20 Bilirubin (µmol / L) 20-32 33-101 102-204 >204 DOP > 1,5 ou EPI > 0,1 ou NOREPI > 0,1 Hypotension (MAP, mmHg, catecholamines in µg/Kg/mn) MAP < 70 DOP ≤ 5 ou DOB DOP > 5 ou EPI ≤ 0,1 ou NOREPI ≤ 0,1 Glasgow score 13-14 10-12 6-9 <6 171-299 300-440 or UO < 500 > 440 or UO < 200 Serum creatinine (µmol/L) or urine output (ml/day) 110-170 |___|10. |___|11. |___|12. |___|13. |___|14. |___|15. MV : mechanical ventilation (invasive or noninvasive ; MAP : mean arterial pressure ; DOP : dopamine ; EPI : epinephrine ; NOREPI : norepinephrine. Catecholamines are taken into account if they were infused during at least 1 hour. □ □ Mechanical Ventilation on RadioDay (invasive or NIV): YES NO 16. In case of NIV, date of initiation: |___||___| / |___||___| / |___||___||___||___| 17. In case of invasive MV, date of initiation: |___||___| / |___||___| / |___||___||___||___| 18. Oxygen requirements: PaO2 (closest measurement to the CXR in the timeframe 12h before/after): In case of mechanical ventilation : |___||___||___|19. (mmHg) FiO2 :------------------------|___||___||___|20. (%) Settled PEEP: -------------------------------|___||___|21. (cmH2O) Otherwise, oxygen output : -------------|___||___|22. (l/min) Indication for the CXR : □ Daily ROUTINE □ SPECIFIC INDICATION 23. In case of « specific indication », which one? (multiple answers are possible) □ Systematic CXR on ICU admission □Respiratory and/or circulatory failure (comprising worsening of an impaired condition). □ Pleuropulmonary follow-up (Atelectasis, pneumonia, ARDS, pleural effusion, pulmonary edema…) □ Fever or inflammatory syndrome investigation □ Search for or follow-up of mediastinal pathology (vessels, heart, effusion…) □ Search for or follow-up of chestwall pathology (ribs, diaphragm…) □ Verification after endotracheal intubation □ Verification after the insertion of device in the superior vena cava □ Verification after gastric tube insertion □ Verification after chest tube insertion □ Verification after chest tube removal □ Verification after pericardial tube insertion □ Verification after pericardial tube removal □ Verification after tracheostomy □ Verification after intra-aortic balloon insertion □ Other : ……………………………………………….. What was the time of this CXR ? 25. □ during the CXR morning round □ unscheduled : At what time ? ----------------------------|___||___|h|___||___|26. Who interpreted this CXR ? □ Intensivist □ Radiologist 24. What were the findings of this CXR ? (Multiple choice) 27. □ No relevant abnormality Was it □ Expected □ Unexpected □ Indwelling device malposition □ Expected □ Unexpected □ A relevant tissular abnormality (pleural, pulmonary, chestwall, mediastinal or even abdominal): Diagnosis Worsening of known Improvement of known abnormality abnormality Expected* Unexpected* Expected Unexpected Expected Unexpected Pleural □ □ □ □ □ □ Parenchymatous □ □ □ □ □ □ Chestwall □ □ □ □ □ □ Mediastinal □ □ □ □ □ □ Abdominal □ □ □ □ □ □ * : Expected or unexpected before the CXR. Commentary (optional) :………………………………………………………………………………. Was the CXR followed by a CHANGE IN CARE MANAGEMENT (including the continuation of a therapy which was scheduled to be interrupted) which WOULD HAVE NOT TAKEN PLACE IF THIS CXR WOULD HAVE NOT BEEN PERFORMED? Yes □ No □ 28. If YES, which one (multiple choice)?) Endotracheal intubation Initiation of NIV Changes in mechanical ventilation settings Chest tube: insertion, repositioning, removal Repositioning of the tracheal tube Repositioning of the gastric tube Respiratory physiotherapy initiation/change/continuation (while interruption was scheduled) Positioning (prone, lateral, upright) Therapeutic bronchoscopy (atelectasis, foreign body) Respiratory sampling Thoracic imaging (CT-scan, cardiac or pleural US) □ Yes □ Yes □ Yes □ Yes □ Yes □ Yes □ Yes □ Yes □ Yes □ Yes □ Yes □ No □ No □ No □ No □ No □ No □ No □ No □ No □ No □ No 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. Antimicrobial therapy initiation/change/continuation (while interruption was scheduled) Yes □ No □40. Yes □ No □41. Yes □ No □42. DIuretics or hydric loss via RRT : initiation/modification/arrêt/poursuite (alors que l’arrêt était prévu) Inotropic drugs: initiation/change/continuation (while interruption was scheduled) Other : ………………………………………………………………………………………….. Commentary (optional) : ……………………………………………………………………………... ABOUT THE ICU NB : Only one form has to be filled for each ICU. Please report the actual habits of your unit rather than your personal opinion. Investigator : -------|___||___||___||___||___||___||___||___||___||___||___||___||___||___| 43. City : -----------|___||___||___||___||___||___||___||___||___||___||___||___||___||___||___||___||___||___| 44. ICU : -------|___||___||___||___||___||___||___||___||___||___||___||___||___||___||___||___| 45. □ Medical ICU □ Neurosurgical ICU □ Medicosurgical ICU □ □ □ Surgical ICU (excluding neurosurgical and cardiothoracic ICU) Cardiothoracic ICU Other : …………………………………………………………………. Number of beds on RadioDay (Excluding the « Unité de Soins Continus »):-------------------|___||___|46. Number of occupied beds on RadioDay (Excluding the « Unité de Soins Continus »):-----|___||___|47. Number of patients under mechanical ventilation on RadioDay (including NIV):-------------|___|48. What is habit of CXR prescription in your ICU? □ □ In all the patients : In mechanically ventilated patients: □ On-demand □ On-demand Daily routine Daily routine 49. 50. In your ICU, which procedure is systematically followed by a CXR? ICU admission:----------------- -------------- □ YES Endotracheal intubation:------------------Gastric tube insertion:---------------------Chest tube insertion : ---------------------Chest tube removal : ---------------------- □ □ □ □ □ □ □ □ □ YES YES YES YES NO 51. NO 52. NO 53. NO 54. NO 55. NO 56. Subclavian or jugular indwelling device insertion : ----------------- □ YES □ Pericard. tube insertion : -------------------- □ □ YES NO 57. Tracheostomy:-----------------------□ YES □ NO 58. Other : …………….…………………………………………………………………………….. 59. Is a written procedure for CXR prescription available? Is a written procedure available □ □ Glycemic control ---------------Sedation -------------------------Who performs the CXR ? □ YES YES Radiographer 24h/24, 7d/7 Intensivist or member of the ICU crew 24h/24 7d/7 □ It depends on the day/hour How does the CXR read □ On film □ YES □ YES □ □ □ □ □ Numerically displayed NO 60. NO 61. NO 62. YES YES □ □ NO 65. 66. NO 63. NO 64. ESM 2: Chest radiographs ordered after invasive procedures. 136 (15.9%) CXRs ordered after invasive procedures ¶ Endotracheal intubation 63 (7.4%) Insertion of vascular access in the superior vena cava 55 (6.4%) Oro- or nasogastric tube insertion 28 (3.3%) Chest tube (insertion) 20 (2.3%) Chest tube (before/after removal) 6 (0.7%) Tracheostomy Legend: CXR: chest radiograph, ICU: intensive care unit. CI95: 95% confidence interval. 7 (0.8%) Results are expressed as n (% of total CXRs ordered on RadioDay, i.e., 854). ¶: among CXRs ordered for checking immediately after an invasive procedure, 29 (3.4% of total CXRs) were performed for this sole indication. †: after exclusion of the CXRs performed at ICU admission and/or after indwelling device insertion with no other reason for ordering the CXR. ESM 3: Influence of the weekday The number of CXRs per patient was not statistically different (p=0.54) from one study day to another: 0.7±0.2, 0.7±0.3, 0.8±0.2 and 0.6±0.4 CXR per patient on Monday (12 ICUs), Tuesday (60 and 12 ICUs on RadioDay#1 and 2, respectively [0.7±0.3 CXR per patient in both]), Wednesday (13 ICUs) and Thursday (7 ICUs), respectively. ESM 4: Clinical value of CXRs after indwelling device insertion. Indwelling device CXR after the insertion* Malposition of the device Vascular access in the superior vena cava ¶ 27 (3.1% of total CXR) 2/27 (7.4%) [expected: n=1] Oro- or nasogastric tube 12 (1.4%) 1/12 (8.3%) [expected: n=1] Chest tube 20 (2.3%) 0 Tracheostomy 7 (0.8%) 0 Legend: CXR: Chest radiograph. *: CXR not ordered for another reason than checking after the indwelling device insertion. ¶: a pleural complication was displayed by the CXR after 2/27 (7.4%) procedures. This complication was expected in the 2 cases. ‘Expected’ denotes that the findings of the CXR was expected by the physician before the CXR was performed.