Hejblum Gilles, Ioos Vincent, Vibert Jean-François, Böelle Pierre-Yves, Chalumeau-Lemoine Ludivine, Chouaid Christos, Valleron Alain-Jacques, Guidet Bertrand
U707, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
Chest. 2008 May;133(5):1107-12. doi: 10.1378/chest.06-3014. Epub 2007 Nov 7.
Strategies for ordering bedside chest radiographs (CXRs) have substantial logistic and financial consequences in the ICU. Many of the indications for CXRs in the ICU are controversial, such as the ordering of daily routine CXRs for intubated patients. The opinions of intensivists about ordering CXRs have not been reported. Comparing these opinions to established guidelines and identifying situations where opinions diverge in the absence of guidelines are of considerable interest.
We asked 190 intensivists from 34 ICUs in the area of Paris, France, to anonymously complete a 29-item questionnaire about their opinions regarding the ordering of CXRs; each item described a clinical scenario. Of the 29 scenarios, 10 dealt with the placement of medical devices, 8 with the presence of medical devices, and 11 with other clinical situations. The study was based on a Delphi process deployed over the Internet through an original software application. Three Delphi rounds were run between January and March 2006, using the same questionnaire. Detailed feedback for the answers given during the previous round was supplied to each intensivist solicited for updating his answers.
Eighty-two intensivists from 32 ICUs completed the study. A consensus emerged that routine CXRs were necessary for eight scenarios and unnecessary for two scenarios. The study also shed light on items without a consensus. In particular, 75% of intensivists (58% on the first round) did not support obtaining daily routine CXRs in intubated patients.
The study underlines situations in which intensivists do not support the guidelines and outlines recommendations likely to be followed in clinical practice.
在重症监护病房（ICU）中，安排床边胸部X光片（CXR）检查的策略会产生重大的后勤和财务影响。ICU中许多进行CXR检查的指征存在争议，例如为插管患者安排每日常规CXR检查。尚未报道过重症监护医生对于安排CXR检查的意见。将这些意见与既定指南进行比较，并确定在没有指南的情况下意见存在分歧的情况，具有相当大的意义。
我们邀请了来自法国巴黎地区34个ICU的190名重症监护医生，匿名填写一份关于他们对安排CXR检查的意见的29项问卷；每个项目描述了一个临床场景。在这29个场景中，10个涉及医疗设备的放置，8个涉及医疗设备的存在，11个涉及其他临床情况。该研究基于通过一个原始软件应用程序在互联网上展开的德尔菲法。在2006年1月至3月期间，使用相同的问卷进行了三轮德尔菲调查。向前一轮给出答案的每位重症监护医生提供详细反馈，以促使其更新答案。
来自32个ICU的82名重症监护医生完成了该研究。对于8个场景达成了常规CXR检查是必要的共识，而对于2个场景则达成了不必要的共识。该研究还揭示了一些未达成共识的项目。特别是，75%的重症监护医生（第一轮为58%）不支持为插管患者进行每日常规CXR检查。
该研究强调了重症监护医生不支持指南的情况，并概述了临床实践中可能遵循的建议。
