荷兰重症监护病房胸部 X 线摄影实践的重大变化：一项基于网络的调查。
Significant changes in the practice of chest radiography in Dutch intensive care units: a web-based survey.
机构信息
Department of Intensive Care, University Medical Center, Postbus 85500, 3508 GA Utrecht, The Netherlands.
出版信息
Ann Intensive Care. 2014 Apr 4;4(1):10. doi: 10.1186/2110-5820-4-10.
BACKGROUND
ICU patients frequently undergo chest radiographs (CXRs). The diagnostic and therapeutic efficacy of routine CXRs are now known to be low, but the discussion regarding specific indications for CXRs in critically ill patients and the safety of abandoning routine CXRs is still ongoing. We performed a survey of Dutch intensivists on the current practice of chest radiography in their departments.
METHODS
Web-based questionnaires, containing questions regarding ICU characteristics, ICU patients, daily CXR strategies, indications for routine CXRs and the practice of radiologic evaluation, were sent to the medical directors of all adult ICUs in the Netherlands. CXR strategies were compared between all academic and non-academic hospitals and between ICUs of different sizes. A comparison was made between the survey results obtained in 2006 and 2013.
RESULTS
Of the 83 ICUs that were contacted, 69 (83%) responded to the survey. Only 7% of responding ICUs were currently performing daily routine CXRs for all patients, and 61% of the responding ICUs were said never to perform CXRs on a routine basis. A daily meeting with a radiologist is an established practice in 72% of the responding ICUs and is judged to be important or even essential by those ICUs. The therapeutic efficacy of routine CXRs was assumed by intensivists to be lower than 10% or to be between 10 and 20%. The efficacy of 'on-demand' CXRs was assumed to be between 10 and 60%. There is a consensus between intensivists to perform a routine CXR after endotracheal intubation, chest tube placement or central venous catheterization.
CONCLUSION
The strategy of daily routine CXRs for critically ill and mechanically ventilated patients has turned from being a common practice in 2006 to a rare current practice. Other routine strategies and an 'on-demand only' strategy have become more popular. Intensivists still assume the value of CXRs to be higher than the efficacy that is reported in the literature.
背景
ICU 患者经常进行胸部 X 光检查（CXR）。现在已经知道常规 CXR 的诊断和治疗效果较低，但关于危重症患者进行 CXR 的具体适应证以及放弃常规 CXR 的安全性的讨论仍在继续。我们对荷兰的重症监护医生进行了一项关于他们科室目前进行胸部 X 光检查的实践情况的调查。
方法
我们向荷兰所有成人 ICU 的医疗主任发送了基于网络的调查问卷，其中包含有关 ICU 特征、ICU 患者、每日 CXR 策略、常规 CXR 适应证以及放射学评估实践的问题。比较了所有学术和非学术医院以及不同规模 ICU 之间的 CXR 策略。比较了 2006 年和 2013 年的调查结果。
结果
联系了 83 个 ICU，其中 69 个（83%）对调查做出了回应。只有 7%的回应 ICU 目前对所有患者进行每日常规 CXR，而 61%的回应 ICU 表示从不进行常规 CXR。72%的回应 ICU 有每日与放射科医生举行会议的惯例，并且认为该惯例很重要，甚至是必不可少的。常规 CXR 的治疗效果被重症监护医生认为低于 10%或在 10%至 20%之间。“按需”CXR 的效果被认为在 10%至 60%之间。在气管插管、放置胸管或中心静脉导管后进行常规 CXR 已成为重症监护医生之间的共识。
结论
对于危重症和机械通气患者进行每日常规 CXR 的策略已从 2006 年的常见做法转变为当前罕见的做法。其他常规策略和“按需”策略变得更加流行。重症监护医生仍然认为 CXR 的价值高于文献中报道的疗效。
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