Current prescription strategies and clinical value of chest

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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.
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