Radiologic clinics of North America
-
Radiol. Clin. North Am. · Jan 1996
ReviewAccuracy and efficacy of chest radiography in the intensive care unit.
In summary, the chest radiograph has only moderate accuracy in visualizing opacification caused by cardiopulmonary abnormalities and may be quite nonspecific as to etiology, whereas it has high diagnostic accuracy for detecting malpositioning of tubes and lines. While focal parenchymal abnormalities are usually visualized on chest radiographs, identification of concomitant abnormalities when ARDS or PE already exist is more difficult. Atelectasis, aspiration, pneumonia, pulmonary hemorrhage, pulmonary thromboembolism, atypical cardiogenic edema, asymmetric ARDS, and neoplasms may be indistinguishable. ⋯ It is also noteworthy that despite the chest film being the most commonly ordered radiologic examination for inpatients, there are no comprehensive studies evaluating its cost-effectiveness. Although several studies have done a very limited cost accounting of the potential savings by eliminating routine films in the evaluation of specific subsets of patients, overall impact on patient outcome has not been investigated. Thus, a true assessment of cost-effectiveness has yet to be determined.
-
Radiol. Clin. North Am. · Jan 1996
ReviewRadiologic evaluation of the patient after cardiac surgery.
The chest radiograph traditionally has played a central role in the preoperative and postoperative care of cardiac surgery patients. Familiarity with the preoperative evaluation, the basics of the process of cardiopulmonary bypass, and the nuances of care in the postoperative period enables the radiologist to provide a more meaningful radiologic consultation.
-
Barotrauma remains a significant complication of mechanical ventilation, particularly in ARDS. A number of alternative techniques for mechanical ventilation are being investigated with the purpose of minimizing ventilator-related lung injury and air leak phenomena while maintaining adequate oxygenation. Among them pressure-controlled inverse-ratio ventilation and extracorporeal carbon dioxide removal have not resulted in a definite reduction of barotrauma thus far. The radiologist plays an important role in the early recognition of barotrauma and may assist in the treatment of its sequelae.