Survey and monitoring of usage of chest radiography and chest ultrasonography in the cardiothoracic perioperative setting
Zlatka Belamarić, Aatif Husain, Giampaolo Martinelli, Gerry Van Rensburg, Greta Giuliano, Suresh Sanapala
St Bartholomew's Hospital, Barts NHS Trust, London, United Kingdom
Respiratory complications remain a leading cause of post cardiac surgical morbidity and can prolong hospital stay and increase costs. Conventional lung imaging in critically ill patients are bedside CXR and lung CT. Lung US is also a tool for assessing lung status in critically ill patients and can be easily used and repeated at the bedside, allowing the effects of therapy to be monitored, as highlighted in the International evidence-based recommendations for point-of-care lung ultrasound published in 2012.
1) To survey if the LUS is utilised in the contexts where it is supported by the literature to be superior and more effective than CXR. 2) To compare if the different modes of investigation are performed in a timely and efficient manner.
This was a local service evaluation held at Barts Heart Centre limited to 4 adult Intensive Care Units. Data collection was obtained from the computer system and patient health records which were held in the Intensive Care Unit.
299 cases of supine AP CXR or LUS were identified in the period from the October 2016 to the February 2017. Overall CXR was used on 277 occasions (93%) whilst LUS was utilised on 22 (7%) occasions. Clinical questions triggering the request for the CXR/ LUS were the presence of pneumothorax, pleural effusion, consolidation, pulmonary oedema and positioning of indwelling devices. Of 108 cases where pneumothorax was suspected, CXR was utilised 106 times (98%) and LUS was utilised on 2 occasions (2%). Of 43 cases where pleural effusion was suspected by the clinician, CXR was utilised 30 times (70%) and LUS was utilised on 13 occasions (30%) Of 29 cases where consolidation was suspected CXR was utilised 27 times (93%) and LUS was utilised on 2 occasions (7%). Of 27 cases where pulmonary oedema was suspected, CXR was utilised 25 times (93%) and LUS was utilised on 2 occasions (7%). On 47 occasions CXR was utilised to ensure positioning of indwelling devices: NG tubes, chest drains, CVC catheters and ET tubes. Only twice was LUS utilised to assist positioning, on both occasions regarding chest drain insertion. The average time from the request of the CXR to the CXR having been performed was 2 hours 18 minutes. Meanwhile, LUS took 57 minutes on average from its request to its performance.
Our service evaluation showed that the most commonly performed investigation was CXR despite the evidence base strongly supporting the use of the LUS which could ameliorate effectiveness and rapidity of the intervention in perioperative care, resulting in the better patient care.
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