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.