Loading presentation...

Present Remotely

Send the link below via email or IM


Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.


Chest radiography in the ICU

Rakesh Mannava

r m

on 24 June 2010

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Chest radiography in the ICU

Efficacy of adhesion barriers in prevention of intrabdominal adhesions Objectives: Critically examine a single study comparing routine vs on-demand chest radiography

Understand the benefits using an on-demand strategy to order CXRs Does daily chest radiography improve outcomes in mechanically ventilated ICU patients? Literature Search Up To Date

"What's New?" section. Looked at the new practice changing guidelines. Hejblum G; Chalumeau-Lemoine L; Ioos V; Boelle PY; Salomon L; Simon T; Vibert JF; Guidet B
Lancet. 2009 Nov 14;374(9702):1687-93. Epub 2009 Nov 4.

Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study. PPICONS and Relevance Problem: number of radiographs taken per patient
Population: mechanically ventilated ICU patients
Intervention: on-demand ordering of radiographs
Comparison: routine daily radiographs
Outcomes: number of radiographs per patient day on mechanical ventilation, days of mechanical ventilation, length of stay in ICU, mortality in ICU
Number: 967 patients 100 patients (5 patients per intensive care unit) would have to be enrolled in each strategy to detect a diff erence of 20% (δ=1·2×0·2), in a bilateral test with a type 1 error of 5% and a power of 80%. Study Design Study Results Followup: until discharge from ICU or 30 days on mechanical ventiltion (whichever first)
Randomization: cluster randomized, crossover,
Intent to treat
Similar: groups were homogenous with the following variables: age, diagnosis mix, SAPS-II score (predicted hospital mortality),
Blinding: none
Equal treatment: all ICUs were treated the same and there was crossover
Validity Overall excellent study! Comments and Questions *21 ICUs in France enrolled *half the centers used routine CXR,
half used on-demand CXR *all mechanically ventilated ICU patients admitted to the units were enrolled in the study *when an individual center got 20 patients it would switch protocols *the researchers analyzed the number of CXRs taken and other outcomes including mortality There was a 32% decrease in the mean number of chest radiographs ordered when ICUs used an on-demand protocol. (p<0.0001) There was no difference in days on mechanical ventilation, length of stay, or ICU mortality between the two protocols.
(p=0.9, 0.28, 0.79 respectively) DOE POEM How much time was lost by using the on-demand strategy?
Physicians would have to analyze the need for a CXR every morning, order it, and then check the results later in the day.
ICU physicians may not be comfortable with fewer CXRs and will have to shift their thinking to change
Study done in entirely France. Health care delivery may be different there, and the findings may not be generalizable to the way we practice medicine in the US. Total number of CXRs that led to a diagnostic or therapeutic intervention was the same between both protocols. (p=0.77) What do we tell physicians? Routine chest radiographs are not necessary in all mechanically ventilated ICU patients
Ordering CXRs as needed can save patients from unnecessary radiation and can reduce costs
Time is necessary to become comfortable with not having a CXR on all patients every morning
Full transcript