The Role Of Bedside Chest Radiography To Follow Up The Diseases In The Intensive Care Unit

Purpose:To summarize the quality, imaging manifestation and follow up changes of the bedside chest radiography, assess the role of bedside chest radiography in the following up diseases of patients in intensive care unit (ICU).Methods:322 cases of patients with 944 chest radiographs (CXRs), including:745 computed radiographies (CR) of 213 patients, and 199 conventional radiographies of 109 patients in the ICU, were analysed retrospectively. The analyzed criteria of CXRs included the imaging appearance of cardiopulmonary abnormalities and malposition or complications of intravascular devices and endotracheal, thoracostomy, or nasogastric tubes.Results:There are 43 (21.6%) film of good quality and 20 (5%) film of bad quality in the 199 conventional bedside chest radiographies of 109 patients. However,59.3% films are good quality, and 1.1% films are bad quality when use CR. Compared with conventional radiographies, the absorbed scattered radiation in the tested and other people in the same room used CR cut down 23.9% and 7.9%, respectively. Combing with digital post-processing techniques, about 98.9% portable chest radiograph (CXR) conform to diagnostic requirements.77.6% of the CXRs showed cardiopulmonary abnormalities, including the air-space diseases with high density (pulmonary atelectasis, pneumonia, pulmonary edema, ARDS, pulmonary hyaline membrane disease of newborn), the abnormal accumulation of air in the chest (pneumothorax, mediastinal emphesema, pneumohypoderma), pleural effussion, hydrops pericardil and pulmonary embolism. The distribution of the lesions, evolvement of disease and whether airbronchgram or not are different between hyaline membrane disease and pneumonia in the newborn patients. In the follow-up radiographies, the hyaline membrane disease need follow up during 1 to 3 days but the pneumonia need follow up during 3 to 5days. About 40% alveolar edema caused by congestive heart failure and ARDS are hard to distinguish. But they are different in heart shadow enlargement, airbronchgram, pleural effusion and kerley's B lines. The alveolus edema just can be improved in 1 to 3 days with cardiotonic and diuretic therapy, so it needs follow-up radiographies in short time. Whereas, the patients with ARDS need follow-up in 1 to 2 weeks.Out of 65 case of severe pneumonia,15 cases had the abnormalities of lung parenchyma and interstitial changes during the stable phase after treatment, which including the changes of the local or catholicity strips, webs, dots shadows and so on. Out of 15 cases,13 cases with the interstitial changes of strip shadows are partly or all absorbed during the later follow-up. 10 patients using immunodepressant have pneumonia, and 8 patients thereinto are polyinfection with mycotic infection. Their films are very complicated and show limited or extensive patching infiltration, cavitary or nodosity shadow. The disease need long time to be improved. 7 patients are improved after 4 weeks.16.7% of all cases with tubes and lines was detected malpositioning, including: too low positioning of the endotracheal (ET) tubes, entrance into the subclavian and internal jugular veins of central venous catheter placement and malfunction of thoracostomy tubes.8 cases of ARDS,10 cases of cardiac pulmonary edema,15 cases of pneumothorax and pleural effusion,4 cases of atelectasis due to spit obstructive,2 cases of pulmonary atelectasis caused by endotracheal tubes too deep are diagnosed by CXR companing with clinical manifestation, and improve after treatments by mechanical ventilation, cardiotonic and diuretic therapy, chest drainage, spit aspiration, and adjust endotracheal tubes, respectively.Conclusions:Compare with conventional radiographies, computed radiographies (CR) have more qualification and less scatter radiation.The bedside chest radiograph can observe dynamically some abnormities. The pulmonary hyaline membrane disease of newborn changed fast, so it must be follow-up radiographies in 1 to 3 days, and the pneumonia of newborn should be in 3 to 5days.In the follow-up of some severe pneumonia, some may show strips or webs shadow which means pulmonary interstitial thickening, which can be absorbed in later time. The pneumonia of the patients who use immunodepressant (after renal transplantation) includes fungus infection, so the course of diseases is long and the follow-up radiographies could be lasted to longer than 4 weeks. The cardiac pulmonary edema changed fast and it should be follow-up radiographies in short time. Diagnose and differential diagnose of less pneumathorax, cardic pulmonary edema and ARDS are improved after anatomizing the bedside chest radiograph combining with clinical analysis.Proper positioning and assessment of abnormalities and complications of the monitoring devices for ICU patients can be diagnosed according to portable chest radiography. The bedside chest radiograph has some limitation but it has importantly role in the etiological diagnosis, therapeutic effect observation and finding new abnormities of ICU patients. It also provides strength evidence for doctors to adjust therapeutic regimen.