In a systematic review and meta-analysis by Ganapathy et al [8] and Mets et al [7] in cardiothoracic surgery patients in the ICU and the post-ICU did not observe any negative influence of on-demand chest radiographs on length of stay in the ICU and hospital, and readmission rate. However, Ganapathy et al [8] observed that CIs were wide and harm was not rigorously assessed. Therefore, they concluded that the safety of abandoning routine chest radiographs in patients admitted to the ICU remains uncertain and mandates further investigation. Current evidence shows that routine daily chest radiographs are not necessary after lung resection because daily imaging in nonhypoxic patients is unlikely to lead to clinically impactful changes in care [15] and because on- demand chest radiographs based on clinical monitoring have a better impact on management without negatively affecting patient outcomes [11]. In another study of 253 LUS examinations, the management was changed directly as a result of information provided by the LUS in 119 out of 253 cases (47%) [3]. In 81 cases, the change in patient management involved invasive interventions, and in 21% of cases, the LUS revealed findings not suspected by the primary physician such as pneumothorax, significant pleural effusion, pneumonia, unilateral atelectasis, and diffuse interstitial syndrome. It was concluded that thoracic US has similar diagnostic accuracy to CT in pleural effusion, consolidation, and pneumothorax [3]. Variant 3: Intensive care unit patient with clinically worsening condition. Initial imaging. Radiography Chest Portable In a survey of Dutch intensivists, there was a consensus between intensivists to perform a routine chest radiograph after endotracheal intubation, chest tube placement, or CVC as well as for diagnostic workups for pneumonia, ARDS, or pneumothorax [6].
Intensive Care Unit Patients. In a systematic review and meta-analysis by Ganapathy et al [8] and Mets et al [7] in cardiothoracic surgery patients in the ICU and the post-ICU did not observe any negative influence of on-demand chest radiographs on length of stay in the ICU and hospital, and readmission rate. However, Ganapathy et al [8] observed that CIs were wide and harm was not rigorously assessed. Therefore, they concluded that the safety of abandoning routine chest radiographs in patients admitted to the ICU remains uncertain and mandates further investigation. Current evidence shows that routine daily chest radiographs are not necessary after lung resection because daily imaging in nonhypoxic patients is unlikely to lead to clinically impactful changes in care [15] and because on- demand chest radiographs based on clinical monitoring have a better impact on management without negatively affecting patient outcomes [11]. In another study of 253 LUS examinations, the management was changed directly as a result of information provided by the LUS in 119 out of 253 cases (47%) [3]. In 81 cases, the change in patient management involved invasive interventions, and in 21% of cases, the LUS revealed findings not suspected by the primary physician such as pneumothorax, significant pleural effusion, pneumonia, unilateral atelectasis, and diffuse interstitial syndrome. It was concluded that thoracic US has similar diagnostic accuracy to CT in pleural effusion, consolidation, and pneumothorax [3]. Variant 3: Intensive care unit patient with clinically worsening condition. Initial imaging. Radiography Chest Portable In a survey of Dutch intensivists, there was a consensus between intensivists to perform a routine chest radiograph after endotracheal intubation, chest tube placement, or CVC as well as for diagnostic workups for pneumonia, ARDS, or pneumothorax [6].