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.
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.
Study Type
OBSERVATIONAL
Enrollment
849
Hopital Saint-Antoine
Paris, Paris, France
Average number of chest radiographs per patient-day during mechanical ventilation
Time frame: Every patient-day during mechanical ventilation.
Mortality rate in ICU
Time frame: During the inpatient stay in ICU
Average length of stay
Time frame: During the inpatient stay in ICU
Average duration of mechanical ventilation
Time frame: During the inpatient stay in ICU
Number of radiographs with new findings leading to therapeutic or diagnostic interventions
Time frame: During the inpatient stay in ICU
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