Chinese Society of Critical Care Medicine-CSCCM 10th Anniversary

讲座摘要

ICU中的胸部X片 Chest X rays in ICU

Bertrand Guidet

讲座课件

Address correspondence to

Pr Bertrand Guidet

Hôpital Saint Antoine Paris

184 Rue du Fg Saint Antoine

Tel: +33 1 49 28 23 19

E-mail: bertrand.guidet@sat.aphp.fr

Abstract

Background

Current guidelines recommend Routine daily chest radiographs (CXRs) for mechanically ventilated patients in intensive care units (ICUs).

However, some ICUs have shifted to an On-demand strategy, in which this CXR is only prescribed if warranted by the patient’s status at the morning physical examination.

Here we compared Routine and On-demand strategies in 21 French ICUs. The working hypothesis was that CXR prescriptions would fall by at least 20% with the On-demand strategy, with no reduction in quality of care.

Methods

Based on a cluster-randomized two-period two-strategies cross-over design, respectively 11 and 10 participating ICUs applied the Routine and On-demand strategies during the first period, each enrolling 20 consecutive patients requiring mechanical ventilation for at least two days.

Each ICUs applied then applied the alternative strategy during the second period, again enrolling 20 consecutive patients.

Findings

Respectively 424 and 425 patients received 4607 and 3148 CXRs with the Routine and On-demand strategies, representing a reduction of 32% with the On-demand strategy (p<10-6).

Similar numbers of CXRs (respectively 728 and 729) led to therapeutic or diagnostic interventions.

The two strategies were associated with similar mean durations of mechanical ventilation (9·82 d and 9·84 d) and ICU stay (13·96 d and 13·21 d), and similar ICU mortality rates (30·9% and 32·0%).

Interpretation

An On-demand prescription strategy reduces CXR consumption with no measurable change in quality of care.

Funding

Assistance Publique–Hôpitaux de Paris (Direction Régionale de la Recherche Clinique Ile de France).

References

Gilles Hejblum, Ludivine Chalumeou-Lemoine, Vincent Loos, et al. Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study. Lancet 2009; 374:1687-93.

第二届中法危重病医学研讨会暨上海重症医学论坛（2009年12月中国上海）