Bedside Chest Radiography

Eisenhuber, Edith; Schaefer-Prokop, Cornelia; Prosch, Helmut; Schima, Wolfgang

doi:10.4187/respcare.01712

Cited by 66 publications

(31 citation statements)

References 57 publications

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“…Additionally, the CXR evaluation provides a significant increase in important information about the patient’s condition, such as the presence of an infiltrate or a pneumothorax or about the position of artificial devices such as central venous catheters or the endotracheal tube [35]. There is no comparable, commonly available and cost-effective diagnostic approach which offers such a wide spectrum of information as that provided by bedside CXRs [36, 37]. …”

Section: Discussionmentioning

confidence: 99%

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

et al. 2014

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BackgroundTo assess the value of a score-based system which allows standardized evaluation of pulmonary edema on bedside chest radiographs (CXRs) under routine clinical conditions.MethodsSeven experienced readers assessed bedside CXRs of ten patients with an extravascular lung water (EVLW)-value of ≤ 8 mL/kg (range: 4–8 mL/kg; indicates no pulmonary edema) and a series of ten patients with an EVLW-value of ≥ 15 mL/kg (range: 15–21 mL/kg; = indicates a pulmonary edema) with and without customized software which would permit a standardized assessment of the various indications of pulmonary edema. The software provides a score that identifies patients with and without pulmonary edema. EVLW-values were measured instantly after bedside CXR imaging using a pulse contour cardiac output (PiCCO) system and served as a reference standard. The patients were non-traumatic and not treated with diuretics or dobutamine during bedside CXR imaging and the PiCCO measurements. Mean sensitivity, specificity, positive and negative predictive value, the percentage of overall agreement and the free-marginal multirater kappa value was calculated for both the standard and the standardized score-based approach. The net reclassification index was calculated for each reader as well as for all readers.ResultsEvaluation of bedside CXRs by means of the score-based approach took longer (23 ± 12 seconds versus 7 ± 3 seconds without the use of the software) but improved radiologists’ sensitivity (from 57 to 77%), specificity (from 90 to 100%) and the free-marginal multirater kappa value (from 0.34 to 0.68). The positive predictive value was raised from 85 to 100% and the negative predictive value from 68 to 81%. A net reclassification index of 0.3 (all readers) demonstrates an improvement in prediction performance gained by the score-based approach. The percentage of overall agreement was 67% with the standard approach and 84% with the software-based approach.ConclusionsThe diagnostic accuracy of bedside CXRs to discriminate patients with elevated EVLW-values from those with a normal value can be improved with the use of a standardized score-based approach. The investigated system is freely available as a web-based application (accessible via: http://www.radiologie.uk-erlangen.de/aerzte-und-zuweiser/edema).

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Section: Discussionmentioning

confidence: 99%

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

et al. 2014

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“…However there is not such a consensus regarding ultrasound benefits in thoracic surgery patients. Different studies have been published proving bedside ultrasound is a valuable tool in the management of these patients [7] [10]- [16], meanwhile other authors have warned about the limitations of the technique [8] [17]- [20].…”

Section: Discussionmentioning

confidence: 99%

The Role of Ultrasound and Air Leak Measurement in Assessing Lung Expansion after Thoracic Surgery

Chavarin¹,

Molins²,

Mier³

et al. 2015

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Objective: To determine if lung ultrasound semiology is applicable to the post-surgical hemithorax, and its value in the evaluation of lung expansion in the postoperative period when paired with the use of digital chest drain systems. Methods: Prospective observational study including all patients undergoing thoracic surgery from June 2012 to March 2013. Patients undergoing pleurodesis or hemodynamically unstable were not considered candidates. Final inclusion in the study was based on the availability of digital chest drain system. A transthoracic lung ultrasound evaluation of the anterior and anterolateral windows was performed 20 minutes after chest drain placement. Presence or not of lung sliding and air leak values taken from the digital chest drain system were recorded. Data were submitted to a binomial classification test for analysis. Results: Forty-nine patients were included, yielding a total of 64 hemithoraces. Lung sliding was seen in 53 cases (82.8%), and an air leak value of 20 ml/min or less in 56 cases (87.5%). Sensitivity was 92.8% (95% CI: 82.6% to 97.9%) and specificity 87.5% (95% CI: 47.3% to 97.9%). Positive predictive value was 98.1%, and negative predictive value was 63.6%. Conclusions: Transthoracic lung ultrasound is a useful technique that can complement the use of digital chest drain systems in the evaluation of post-surgical lung expansion. The incorporation of lung ultrasound can greatly reduce the need for chest radiographs in thoracic surgery departments.

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“…The practice of daily CXR was defended by studies that reported a high incidence of new or unexpected findings that presumably would have escaped diagnosis and treatment based on the clinical exam alone. 55,56 This research suggested that early detection could prompt changes in treatment that reduced the rates of complications. Recent studies, however, assert that these conclusions not only overestimate the diagnostic value of chest radiography but also overestimate the likelihood that new radiographic findings actually result in meaningful changes in patient care.…”

Section: Eq 1: Domentioning

confidence: 99%

Less Is More in the ICU: Resuscitation, Oxygenation and Routine Tests

Gopalratnam

Forde

O'Connor

et al. 2016

Semin Respir Crit Care Med

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The intensive care unit (ICU) was initially developed in the 1950s to treat patients who required invasive respiratory support and hemodynamic resuscitation. Since the beginning, ICU medicine has focused on maintaining sufficient arterial blood flow and oxygenation to provide adequate tissue oxygen delivery to forestall or reverse organ failure. Over time, ICU medicine became more intensive, with the administration of many diagnostic tests and monitors, invasive procedures, and treatments, often with scant evidence of benefit associated with them. An alternative perspective holds that ICU patients may represent a group of patients that is especially vulnerable to iatrogenic harm. We outline a case that presents common ICU dilemmas and discusses current data that propose that "less is more" when making key diagnostic or therapeutic choices in the ICU. Further, we assert that providers should skeptically consider common ICU interventions, trying to account for the potential unintended consequences of interventions. Finally, we suggest that the guiding principle of ICU medicine should be primum non nocere: in delicate situations, it may be better not to do something, or even to do nothing, rather than risk causing harm.

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Bedside Chest Radiography

Cited by 66 publications

References 57 publications

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach

The Role of Ultrasound and Air Leak Measurement in Assessing Lung Expansion after Thoracic Surgery

Less Is More in the ICU: Resuscitation, Oxygenation and Routine Tests

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