tailieunhanh - Báo cáo hóa học: "An integrated approach for prescribing fewer chest x-rays in the ICU"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: An integrated approach for prescribing fewer chest x-rays in the ICU | loos et al. Annals of Intensive Care 2011 1 4 http content 1 1 4 o Annals of Intensive Care a SpringerOpen Journal REVIEW Open Access An integrated approach for prescribing fewer chest x-rays in the ICU Vincent Ioos1 Arnaud Galbois2 3 4 Ludivine Chalumeau-Lemoine5 Bertrand Guidet2 6 7 Eric Maury2 6 7 Gilles Hejblum6 7 8 Abstract Chest x-rays CXRs are the main imaging tool in intensive care units ICUs . CXRs also are associated with concerns inherent to their use considering both healthcare organization and patient perspectives. In recent years several studies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a decrease may result from two independent and complementary processes a raw reduction of CXRs due to the elimination of unnecessary investigations and replacement of the CXR by an alternative technique. The goal of this review is to outline emblematic examples corresponding to these two processes. The first part of the review concerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated patients and adopting an on-demand prescription strategy. The second part of the review addresses the use of alternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography combined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography is then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces as well as a valuable post-procedural technique after central venous catheter insertion. The combination of the emblematic examples presented in this review supports an integrated global approach for decreasing the number of CXRs ordered in the ICU. Introduction Among investigations performed daily in the Intensive Care Unit ICU bedside chest x-rays CXRs are completely trivialized. However such CXRs are sources of discomfort and irradiation

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