The role of the chest radiograph in the management of patients admitted to the intensive care unit at Kenyatta National Hospital and Nairobi Hospital

Abstract

There were 33,748 chest radiographs done in the whole of Kenyatta National Hospital (KNH) in 1998 out of which 831 were done in the intensive care unit (ICU) (1). This high figure is consistent with earlier findings which showed that the chest X-ray examination is the second commonest performed radiological examination with a frequency of 28.9% (2). Patients in the intensive care unit have various cardiopulmonary disorders and are frequently monitored and supported by various mechanical devices that make physical and radiological examinations difficult. The later is due to difficulties encountered in positioning and setting out exposure factors in an ICU set up. These two factors were also found to be the leading contributors to the rejection of chest films which stood at 28.5% of the films rejected in KNH and 18.5% of the films rejected at Aga Khan Hospitals in Nairobi (3). The patients in an ICU are often unable to communicate verbally (5) to their physicians and are bed ridden for long hours, a factor which predisposes them to chest infections e.g. pneumonia which can be endogenous in origin or from contaminated catheters and tubes (11). The chest radiograph has been found to be effective in diagnosing various chest pathologies and in some occasions the first indicator of change in patients status. (6,9,11). Indeed the exact position of tubes, lines and pacemakers cannot be determined by any other method (5). There are no studies which have been done in out set up to evaluate the value of the chest film in the management of the critically ill and to document our experience in the use of this imaging modality. This study is aimed at filling this gap in knowledge.