Chest radiography in the critically ill

Introduction:
The chest radiograph (CXR) is a frequently obtained test to complement physical examination in ICU and post-surgery PACU patients. The opinion on indications for a CXR in these two patient categories varies worldwide. One approach is to obtain CXR on indication only, i.e., when there is a reason to obtain a CXR (so-called ‘on demand’ CXRs). Another approach is to obtain a CXR routinely, i.e., on admission to the ICU or PACU (so-called ‘routine admission’ CXRs) and/or daily thereafter. These CXRs are obtained shortly after admission (so-called ‘routinely obtained admission CXRs’) to the ICU or PACU, and every next day (so-called ‘daily routine’ CXRs), even when there has been no change in the clinical condition and/or treatment.
Aims and hypotheses of this thesis:
This thesis is a collection of studies evaluating the clinical value of the CXR in intensive care unit (ICU) and post-anesthesia care unit (PACU) patients.
Conclusion:
The clinical value of the routinely obtained CXRs in intensive care units and post-anesthesia care units is low. We conclude that elimination of daily routine CXRs does not negatively impact outcome of ICU patients. As for the other routinely obtained CXRs we think that ordering these test should be further reviewed.