Restricted versus liberal bedside chest X-ray in ICU, single center comparative study

Abstract Introduction Lung ultrasonography (LUS) use is increasing nowadays in intensive care units (ICU). Routine chest X-ray is still a common practice in many hospitals especially for ventilated patients. We aimed at reducing the number of chest X-rays in ICU and comparing patients’ data in 6 months periods before and after restriction decision. Patient and methods After approval of local hospital administration and ethics committee a project of reducing number of chest X-rays done bedside in ICU and replacing it with LUS if possible, applied for 6 months from October 2020 to March 2021 (restriction period) and all patients’ data were compared to 6 month before applying restrictions from March 2020 to August 2020 (liberal period), excluding month of September as transition between two periods. Results A total of 192 admissions and 941 patient days in liberal period compared to 135 admissions and 649 patient days in restriction period with significant reduction of number of chest X-rays from 732 to 219 with ratio of X-ray /patient days reduced from 77.8% to 33.7% ( p value < 0.001). No significant change observed between both periods regarding procedures done in ICU as tracheostomy, bronchoscopy, central line insertion and chest tube insertion adjusted for number of patients’ days. (p value of 0.193, 0.193, 0.253 and 0.252). VAP and CAUTI remained at zero levels in both periods, however 3 cases of CLABSI were seen in the restriction period which showed no significant difference as p value of 0.068. Mortality ratio was not significantly different in both periods (4.2% in liberal period vs. 7.4% in restriction period with p value of 0.206 while average length of stay decreased significantly from 6.94 ± 1.47 days in liberal period to 6.33 ± 1.33 in restriction period with p value < 0.001. Conclusions Restriction of bedside Chest X-ray orders in ICU environment resulted in significant reduction of performed Chest X-rays with no significant changes in ICU key performance indicators.