Exploring the Necessity of Routine Daily Chest X-rays for Mechanically Ventilated Patients in the Pediatric Intensive Care Unit: An Integrative Review

Abstract

ProblemIn the PICU of a university teaching hospital, daily chest X-rays (CXR) are performed on all intubated and non-invasive ventilation-assisted patients, even when the patient is stable with no changes in clinical status. Inconsistent practice was identified with PICUs globally. This review aims to address the risk-benefit balance of clinical value, outcomes, cost, and radiation exposure when performing routine daily CXRs in the PICU. Eligibility criteriaCINAHL, Medline, and Embase (Ovid) were searched for relevant articles within the last ten years (2009 to 2019). Articles involving routine daily CXR on adult patients were included due to limited pediatric research. Sample18 articles were included in this review which evaluated the necessity of routine daily CXR protocol in the ICU setting and the risks of radiation exposure (pediatric n = 5, adult n = 10, both n = 3). ResultsWhen comparing the routine daily to on-demand CXR ordering protocols, there was no difference noted in clinical outcomes including mortality, complications, length of stay in hospital or ICU, and number of ventilator days. The on-demand CXR protocol decreased the number of CXRs per patient, which thereby decreased radiation exposure for patients, decreasing their risk of potential toxicity and malignancy. ConclusionRoutine daily CXR protocols are no longer recommended due to lack of clinical value, similar outcomes, increased cost, and since it places patients at risk for undue radiation exposure. ImplicationsFurther studies should evaluate clinical and physical exam findings that would trigger ordering a CXR in order to optimize their diagnostic value in the pediatric setting.