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'On-Demand' vs. Daily Chest Radiographs for Patients on Mechanical Ventilation
For mechanically ventilated ICU patients, performing chest radiographs as needed rather than daily can lead to more efficient care without compromising patients' safety, according to a Lancet study.
The study included 21 ICUs and nearly 850 patients in France. The ICUs were randomized to perform daily chest radiographs, or to follow an "on-demand" strategy whereby radiographs were performed only if necessary based on patients' morning exams (all ICUs performed additional radiographs as needed throughout the day). The ICUs followed their randomized strategy until all patients were discharged or had been on ventilation for 30 days. Then, they crossed over to the other strategy.
The mean number of radiographs per patient-day was 32% lower with on-demand than with daily radiographs (0.75 vs. 1.09). This reduction was achieved without adverse effects on mortality, number of days on ventilation, or length of ICU stay.
The authors say their findings "strongly support" on-demand radiography over a routine strategy.
LINK(S):
Lancet article (Free abstract; full text requires subscription)
Lancet comment (Subscription required)
Journal Watch General Medicine coverage of previous study questioning daily chest x-rays in the ICU (Your Journal Watch registration required)
Published in Physician's First Watch November 5, 2009
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