Hall J B, White S R, Karrison T
Department of Medicine, University of Chicago Hospitals and Clinics, IL.
Crit Care Med. 1991 May;19(5):689-93. doi: 10.1097/00003246-199105000-00015.
To determine the efficacy of daily routine chest radiographs in intubated, mechanically ventilated patients.
With approval of our Institutional Review Board, data were collected prospectively to compare bedside clinical assessment of the patient with the routine chest radiograph in determining the occurrence of new findings. Before review of the daily chest film, patients underwent careful evaluation of clinical and physiologic variables by critical care physicians, who then documented the new findings and the diagnostic and therapeutic interventions required. These results were compared with the interpretations of the daily chest film by radiologists blinded to the clinical assessment. Correlations were made of the new major (requiring immediate intervention) and new minor (abnormal but not requiring immediate intervention) findings noted by clinical assessment and chest radiography.
This study was conducted in a ten-bed medical/surgical ICU admitting 650 to 750 patients/yr, a majority of whom require intubation and mechanical ventilation.
Seventy-seven episodes of intubation and mechanical ventilation in 74 patients were evaluated. Only patients with translaryngeal intubation and a requirement for mechanical ventilation beyond 24 hrs were considered for inclusion in this study. Major admitting diagnoses included malignancy, aspiration pneumonia, sepsis, liver failure, chronic obstructive pulmonary disease, and adult respiratory distress syndrome.
Specific interventions were not made by study design; instead, clinical practice with and without the routine chest radiograph was compared.
The measure of comparison between the chest radiograph and clinical assessment was the correlation between the two for a number of major and minor findings defined in advance. A total of 538 chest radiographs were examined; of these, 354 (65.8%) did not disclose either new major or new minor findings as defined. One hundred sixty-three radiographs disclosed only new minor findings, 40.5% of which were anticipated by bedside assessment. However, in 13 (17.6%, 95% confidence interval 9% to 26%) of our 74 patients, new major findings were discovered only by chest radiography.
These data demonstrate that, while a large percentage of radiographs will not disclose new findings, routine daily studies have a substantial impact on the management of intubated, mechanically ventilated patients in the ICU. These findings support the use of daily chest radiographs in critically ill patients.
确定每日常规胸部X线片对插管并接受机械通气患者的疗效。
经机构审查委员会批准，前瞻性收集数据，以比较患者的床边临床评估与常规胸部X线片在确定新发现方面的情况。在查看每日胸部X线片之前，重症监护医生对患者的临床和生理变量进行仔细评估，然后记录新发现以及所需的诊断和治疗干预措施。将这些结果与对临床评估不知情的放射科医生对每日胸部X线片的解读进行比较。对临床评估和胸部X线检查发现的新的主要（需要立即干预）和新的次要（异常但不需要立即干预）发现进行相关性分析。
本研究在一家拥有10张床位的内科/外科重症监护病房进行，该病房每年收治650至750名患者，其中大多数需要插管和机械通气。
对74例患者的77次插管和机械通气情况进行了评估。本研究仅纳入经喉插管且机械通气时间超过24小时的患者。主要入院诊断包括恶性肿瘤、吸入性肺炎、败血症、肝功能衰竭、慢性阻塞性肺疾病和成人呼吸窘迫综合征。
根据研究设计未采取特定干预措施；而是比较了有和没有常规胸部X线片时的临床实践。
胸部X线片与临床评估之间的比较指标是二者在一些预先定义的主要和次要发现方面的相关性。共检查了538张胸部X线片；其中，354张（65.8%）未显示出所定义的新的主要或新的次要发现。16三张X线片仅显示新的次要发现，其中40.5%可通过床边评估预测到。然而，在我们的74例患者中，有13例（17.6%，95%置信区间9%至26%）仅通过胸部X线检查发现了新的主要发现。
这些数据表明，虽然很大比例的X线片不会显示新发现，但每日常规检查对ICU中插管并接受机械通气患者的管理有重大影响。这些发现支持对重症患者使用每日胸部X线片。
