Abstract
Chest x-rays (CXRs) are the main imaging tool in intensive care units (ICUs). CXRs also are associated with concerns inherent to their use, considering both healthcare organization and patient perspectives. In recent years, several studies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a decrease may result from two independent and complementary processes: a raw reduction of CXRs due to the elimination of unnecessary investigations, and replacement of the CXR by an alternative technique. The goal of this review is to outline emblematic examples corresponding to these two processes. The first part of the review concerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated patients and adopting an on-demand prescription strategy. The second part of the review addresses the use of alternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography combined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography is then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces, as well as a valuable post-procedural technique after central venous catheter insertion. The combination of the emblematic examples presented in this review supports an integrated global approach for decreasing the number of CXRs ordered in the ICU.
Highlights
Among investigations performed daily in the Intensive Care Unit (ICU), bedside chest x-rays (CXRs) are completely trivialized
It is essential to assess whether it is possible to reduce the number of CXRs performed during an ICU stay without impairing the quality of care
This study strongly suggests that routine daily CXRs in the ICU patient on mechanical ventilation should be abandoned
Summary
Among investigations performed daily in the Intensive Care Unit (ICU), bedside chest x-rays (CXRs) are completely trivialized. This local protocol combining colorimetric capnography and epigastric auscultation had a perfect specificity to confirm correct EFT placement, improves nurse’s organization of care, saves time, and decreases costs [34,35] We recommend performing a CT scan if doubt persists, especially if new chest tube insertion is under consideration These excellent performances make pleural ultrasonography more than an alternative to CXR and should be considered as the “bedside gold standard” to diagnose and monitor pneumothorax. Ultrasound guidance increases the success rate of CVC insertion, saves time, and decreases the complication rate [52] Considering these results, it appears logical to use the same ultrasonographic device to assess both the adequate position of the CVC and the absence of pneumothorax after the procedure. Ultrasonography could be proposed for assessing the absence of misplacement and pneumothorax while limiting CXR requirement to incomplete ultrasonographic analysis
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