Utility of chest radiographs in management of patients in Intensive Care Unit at Kenyatta National Hospital.
Abstract
Background and purpose - The chest radiograph is the most commonly requested and
performed radiographic examination in the Intensive Care Unit (ICU) and often allows prompt
detection of problems that could be 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- The aim of study was to evaluate the role of chest radiography in patients admitted in
the intensive care unit at Kenyatta National Hospital (KNH) and evaluate the accuracy of tube
placement. This information will be important in designing and implementing appropriate
interventions in patient care for the KNH ICU and providing quality feedback.
Study Design - a prospective cross-sectional study
Setting - Kenyatta National Hospital Intensive Care Unit (KNH ICU).
Methods - During the study period, (December 2013-February 2014) all chest radiographs in the
ICU, were reviewed by the principal investigator and a consultant radiologist. The findings were
entered into the data collection form of each participant.
Data management and analyses – Statistical analysis was done using statistical package for
social scientists (SPSS) version 20.0. Descriptive statistics are presented using percentages and
frequencies for categorical and nominal data while mean, standard deviation, median, minimum
and maximum are used to summarize continuous/discrete variables.
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 98 were 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- There is a significantly high rate of tube and catheter misplacement in KNH ICU
and routine CXR has a role in identifying the malpositioned devices, associated complications
and providing feedback for implementing quality assurance.
Citation
Masters Degree In Diagnostic Imaging And Radiation MedicinePublisher
University Of Nairobi