Routine versus on-demand chest radiographs in mechanically ventilated adults
Hejblum 2009 trial design and results
Design
Multicentre, cluster-randomised, two-period crossover study
Treatment
On-demand chest radiographs
Control
Routine daily chest radiographs
Population
849 mechanically ventilated adults across 21 intensive care units
Follow-up
ICU stay
Primary endpoint
Mean number of chest radiographs per patient-day of mechanical ventilation
Result
424 patients had 4607 routine radiographs (mean 1.09 per patient-day, 95% CI 1.05 to 1.14) and 425 had 3148 on-demand radiographs (mean 0.75, 0.67 to 0.83) — a 32% reduction (95% CI 25 to 38, p<0.0001), with no reduction in quality of care or safety.
Secondary endpoints
Length of ventilation, ICU stay, mortality, delayed diagnoses
Our results strongly support adoption of an on-demand strategy in preference to a routine strategy to decrease use of chest radiographs in mechanically ventilated patients without a reduction in patients' quality of care or safety.
The trial authors, in the published abstract
How it has aged
A de-implementation trial, and a rare one that changed behaviour. The daily ventilated chest film was routine everywhere in 2009; the case for it has not recovered.
Publications
Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study
Hejblum G, Chalumeau-Lemoine L, Ioos V, et al. Comparison of routine and on-demand prescription of chest radiographs in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study. Lancet 2009 Nov 14;374(9702):1687-93.
32% fewer chest radiographs with an on-demand strategy