Although the consensus opinion of the American College of Radiology is that daily routine chest radiographs (routine CXRs) are indicated in all ventilated patients (http://www.acr.org), studies suggest that routine CXRs can be safely abandoned (Krivopal, Chest 2004; Price, CCM 2000).
To ascertain current practice of CXRs in Dutch ICU-patients, a questionnaire was sent to ICUs throughout the Netherlands. Questionnaires were sent to the lead clinicians of ICUs with > 5 beds.
From the number of units responding (n = 28, 43.1%), the majority (n = 17, 60.7%) practiced a routine CXR-strategy, as opposed to a CXR on indication-approach. In most ICUs it was deemed necessary to have (routine) CXRs to ordeal on the presence or absence of ARDS, pneumonia or pneumothorax (n = 20; 71.4%, n = 19; 67.9% and n = 21; 75.0%, respectively), as well as the position of invasive devices (n = 21; 75.0%). In most hospitals a daily meeting with the radiologist was held to discuss CXRs (n = 19; 67.9%), but in more than half of hospitals the ICU-physician thought that radiologists were not experienced enough to adequately judge CXR of critically ill patients (n = 16; 57.1%). If a CXR was judged to be indicated, the reasons were in the majority of ICUs: introduction of invasive devices, such as endotracheal tubes, intravenous lines and thoracic drains (n = 22; 78.6%, n = 21; 75.0% and n = 27; 96.4%, respectively), and hemodynamic/ventilatory deterioration (n = 14; 50.0%); surprisingly, CXRs were also performed after resuscitation (n = 12; 42.9%) and (mini)-tracheotomy (n = 18; 64.3%). Finally, most ICU-physician thought that CXRs, either routine or on demand, influenced daily practice in not more than 20% of performed CXRs.
In the Netherlands, the majority of ICUs still use routine CXRs, although this survey suggests that a large number of intensivists is doubting its value.
There is important lack of concensus on usefulness of routine CXRs in the Netherlands.
Marcus Schultz, None.