Value of routine daily chest x‐rays in the medica intensive care unit
Value of routine daily chest x‐rays in the medica intensive care unit
复制标题
重症监护病房每日常规胸部X光检查的价值
作者：
D. S. Strain;L. Vereen;R. George
为了确定每日常规胸部X线检查在内科ICU中的价值，我们前瞻性地确定了在507个连续胸部X线片上观察到的意外异常的数量，以及94个ICU患者随后的管理变化。初步诊断分为肺，血流动力学不稳定的心脏，简单的心脏，或杂项。排除入院时的影像和术后拍摄的影像或临床状态的变化。还记录了呼吸机状态以及胶片上可见的管路和导管。在临床评估后，ICU医生制定了管理计划，然后检查了胸部X线片，发现了意外异常和由此产生的管理变化。在507例胸片中，76例（15%）显示意外异常，其中71例（93%）导致管理变更。在肺部和不稳定心脏病患者中，与呼吸机状态无关的意外异常和管理变化显著（p <0.02）。胸片上可见两个或更多导管和/或管道的患者也有更多的管理变化（51/312 vs. 11/150，p <0.05）。我们的结论是，虽然常规胸片会影响ICU中肺部和不稳定心脏病患者的管理，但常规胸片很少影响无并发症心脏病患者和无心脏或肺部疾病患者的管理，因此在该组中不必要。
To ascertain the value of the daily routine chest x-ray in the medical ICU, we determined prospectively the number of unsuspected abnormalities observed on 507 consecutive chest films and the consequent management changes in 94 ICU patients. Primary diagnoses were classified as pulmonary, hemodynamically unstable cardiac, uncomplicated cardiac, or miscellaneous. Admission films and those taken after procedures or a change in clinical status were excluded. Ventilator status and the tubes and catheters visible on the films were also noted. After clinical evaluation, management plans were made by ICU physicians and then the chest x-ray was examined and unsuspected abnormalities and resulting management changes were noted. Of the 507 chest films, 76 (15%) revealed an unsuspected abnormality, 71 (93%) of which led to a management change. There were significantly (p < .02) more unsuspected abnormalities and management changes, in the pulmonary and unstable cardiac patients, independent of ventilator status. Patients with two or more catheters and/or tubes visible on the chest film also had significantly more management changes (51/312 vs. 11/150, p < .05). We conclude that while routine chest films affect the management of pulmonary and unstable cardiac patients in the ICU, routine films rarely influence management of uncomplicated cardiac patients and those without heart or lung disease, and are not warranted in this group.