Current guidelines recommend Routine daily chest radiographs (CXRs) for mechanically ventilated patients in intensive care units (ICUs). However, some ICUs have shifted to an On-demand strategy, in which this CXR is only prescribed if warranted by the patient's status at the morning physical examination. Here the investigators compared Routine and On-demand strategies in 21 French ICUs. The working hypothesis was that CXR prescriptions would fall by at least 20% with the On-demand strategy, with no reduction in quality of care.
Primary Outcome Measures:
- Average number of chest radiographs per patient-day during mechanical ventilation [ Time Frame: Every patient-day during mechanical ventilation. ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- Mortality rate in ICU [ Time Frame: During the inpatient stay in ICU ] [ Designated as safety issue: Yes ]
- Average length of stay [ Time Frame: During the inpatient stay in ICU ] [ Designated as safety issue: No ]
- Average duration of mechanical ventilation [ Time Frame: During the inpatient stay in ICU ] [ Designated as safety issue: No ]
- Number of radiographs with new findings leading to therapeutic or diagnostic interventions [ Time Frame: During the inpatient stay in ICU ] [ Designated as safety issue: No ]
| Enrollment: |
849 |
| Study Start Date: |
December 2006 |
| Study Completion Date: |
April 2009 |
| Primary Completion Date: |
August 2007 (Final data collection date for primary outcome measure) |
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1
Routine strategy of chest radiograph prescription
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2
On-demand strategy of chest radiograph prescription
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Based on a cluster-randomized two-period two-strategies cross-over design, respectively 11 and 10 participating ICUs applied the Routine and On-demand strategies during the first period, each enrolling 20 consecutive patients requiring mechanical ventilation for at least two days. Each ICUs applied then applied the alternative strategy during the second period, again enrolling 20 consecutive patients.
Purpose
