Utility of chest radiographs in management of patients in the intensive care unit at Kenyatta National Hospital

Abstract

Background: The chest radiograph is the most commonly requested and performed radiographic examination in the Intensive Care Unit (ICU). It allows rapid detection of pathology that could be easily missed by clinical evaluation and thus enables earlier treatment of clinically unsuspected abnormalities, documentation of disease progression and response to therapy. Assessment of correct placement of lines, endotracheal tubes and catheters is primarily done by use of chest radiographs and if malpositioned, repositioning must be done without delay.

Objective: to determine the utility of routine chest radiographs in clinical decision making in the intensive care unit at Kenyatta National Hospital (KNH).

Study Design: A prospective cross-sectional study

Setting: KNH ICU ward.

Results: The study included 396 chest radiographs done in KNH ICU, among patients with median age 32 years (IQR 12-57) with males contributing 55.1% of films. The main presentations on admission to ICU were road traffic accident (36%, 143), severe chest infections (23%, 91) and major cardiovascular diseases (14%, 54). A total of 293 films had at least one medical device placement (CVC-208,ETT- 141, and chest tubes - 49) which was visualized on CXR and 98were incorrectly placed (CVC- 58 ,ETT-23 and chest tubes-17). There were 52 cases which developed complications post device placement with common complications associated with CVC. Aspiration pneumonia (50%) and atelectasis (15%) were among the commonest complications following device placement.

Conclusion: In conclusion the findings presented in this study show that routine chest radiographs play a vital role in clinical decision making in the intensive care unit. The specific contribution included evaluation of medical device placement and development of complications.