Houghton Douglas, Cohn Stephen, Schell Vaunne, Cohn Kelly, Varon Albert
University of Miami/Jackson Memorial Hospital, FL, USA.
Am J Crit Care. 2002 May;11(3):261-5.
Pulmonary artery catheters are widely used invasive monitoring devices in critically ill patients. Clinicians disagree about whether daily chest radiographs are needed or clinical parameters alone are sufficient to verify catheter placement.
To determine whether daily chest radiographs are needed to assess migration of pulmonary artery catheters.
One hundred consecutive patients with pulmonary artery catheters were prospectively evaluated. Clinical criteria for optimal position of the pulmonary artery catheters and findings on chest radiographs were compared. Optimal clinical criteria were (1) amount of air required to measure pulmonary capillary wedge pressure: 1.25 to 1.5 mL and (2) pulmonary artery catheter migrated 1 cm or less from initial position.
Three hundred ninety comparisons of clinical criteria and radiographic findings were done. Chest radiographs indicated the catheter required repositioning in 15 (4%) of 390 instances but in only 4 (1%) of 310 instances in which bedside clinical findings indicated adequate catheter position. In 69 (18%) of the 390 cases, the clinical criteria for adequate catheter position were not met, but radiographs showed the catheter in an appropriate position. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of abnormal clinical criteria were 73%, 82%, 81%, 14%, and 99%, respectively.
Chest radiographs indicated that about 4% of catheters required repositioning. Catheter malposition can be reliably excluded (negative predictive value, 99%) by close observation of specific clinical criteria, so routine daily chest radiographs do not seem justified.
肺动脉导管是重症患者广泛使用的侵入性监测设备。临床医生对于是否需要每日进行胸部X线检查，还是仅靠临床参数就足以确认导管位置存在分歧。
确定评估肺动脉导管移位是否需要每日进行胸部X线检查。
对100例连续使用肺动脉导管的患者进行前瞻性评估。比较肺动脉导管最佳位置的临床标准与胸部X线检查结果。最佳临床标准为：(1)测量肺毛细血管楔压所需的气量：1.25至1.5 mL；(2)肺动脉导管自初始位置移位1 cm或更少。
对临床标准和影像学检查结果进行了390次比较。胸部X线检查显示，在390例中有15例(4%)导管需要重新定位，但在床边临床检查结果显示导管位置合适的310例中，只有4例(1%)需要重新定位。在390例中的69例(18%)中，未达到导管位置合适的临床标准，但X线检查显示导管位置合适。异常临床标准的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为73%、82%、81%、14%和99%。
胸部X线检查显示约4%的导管需要重新定位。通过密切观察特定临床标准可可靠排除导管位置不当（阴性预测值为99%），因此每日进行常规胸部X线检查似乎没有必要。
