Mark Soth, MD
In mechanically ventilated adults, how does on-demand ordering of chest radiographs compare with routine daily ordering for total number of chest radiographs performed per day?
Cluster-randomized, controlled, crossover trial. ClinicalTrials.gov NCT00893672.
30 days or discharge from intensive care unit (ICU).
13 medical, 2 surgical, and 6 mixed closed ICUs in France.
967 adults who were admitted to the ICU during 2 specified treatment periods and were receiving mechanical ventilation at the time of morning rounds. Exclusion criterion was mechanical ventilation < 2 days. 849 patients (mean age 62 y, 62% men) had ≥ 2 days of mechanical ventilation and were enrolled.
21 ICUs were randomly allocated to 1 of 2 radiograph-ordering strategies during the first period and crossed over to the alternate strategy during the second period, with a 1-week wash-out between periods. Overall, 425 patients received on-demand ordering of chest radiographs as warranted by physical examination findings on morning clinical rounds; 424 patients had routine daily ordering of chest radiographs. Additional chest radiographs could be requested as needed by the clinical team.
Mean number of chest radiographs per patient-day of mechanical ventilation. Secondary outcomes were mechanical ventilation days, length of ICU stay, and ICU mortality.
On-demand chest radiograph ordering reduced the total number of chest radiographs performed per patient-day of mechanical ventilation compared with routine daily chest radiograph ordering (Table). Groups did not differ for length of mechanical ventilation or ICU stay, or mortality (Table).
In mechanically ventilated adults, on-demand ordering of chest radiographs reduced the number of chest radiographs performed per day compared with routine daily ordering.
On-demand vs routine ordering of chest radiographs for mechanically ventilated adults†
†ICU = intensive care unit; other abbreviations defined in Glossary. RRI, NNH, and CI calculated from data in article.
Mark Soth. On-demand ordering of chest radiographs reduced the number of chest radiographs in mechanically ventilated adults. Ann Intern Med. 2010;152:JC3–7. doi: 10.7326/0003-4819-152-6-201003160-02007
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Published: Ann Intern Med. 2010;152(6):JC3-7.
Emergency Medicine, Mechanical Ventilation, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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