HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

LUNG RADIOGRAPHYIN INTENSIVE CARE UNIT

Ömer Zühtü Yöndem

Lokman Hekim University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Türkiye

Yöndem ÖZ. Lung Radiography in Intensive Care Unit. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.419-431.

ABSTRACT

Lung radiography is a fundamental imaging technique in the intensive care unit (ICU), primarily used to evaluate the placement of life-support devices and detect complications such as atelectasis, pneumonia, pneumothorax, and pulmonary edema. Although daily chest radiographs are routinely performed in ICU patients, it has been shown that they have minimal impact on mortality and hospital length of stay. Consequently, the American College of Radiology recommends imaging only if there is a change in clinical situation or after the placement of critical support devices. This review examines the role of portable chest radiography in ICU settings, emphasizing its application in monitoring mechanical ventilation, enteric tubes, central venous catheters, chest tubes, and cardiovascular support devices. Additionally, it highlights the radiographic features of common lung pathologies encountered in ICU patients, including aspiration, acute respiratory distress syndrome, and pulmonary embolism. Particular attention is given to complications arising from the misplacement of tubes and catheters, as these can result in severe clinical consequences. Although portable radiography remains the most accessible imaging tool, advancements in thoracic ultrasound and computed tomography provide alternative methods for improved diagnosis. A comprehensive understanding of ICU radiography is crucial for optimizing patient outcomes and minimizing unnecessary imaging.

Keywords: Intensive care unit; Radiography, Thoracic; Respiration, Artificial; Portable x-ray

Referanslar

  1. Subba R. Digumarthy. Problem solving in chest imaging. In: Steven Zangan, Rishi Ramakrishn, Chapter 39 Intensive Care Imaging. 1st ed. Philadelphia, PA: Elsevier, Inc; 2020 p.618-629. ISBN: 978-0-323-04132-4. [Link]
  2. Scott J, Waite S, Napolitano A. Restricting Daily Chest Radiography in the Intensive Care Unit: Implementing Evidence-Based Medicine to Decrease Utilizationt. J Am Coll Radiol. 2021;:354-360. [Crossref]  [PubMed]  [PMC]
  3. Expert Panel on Thoracic Imaging; Laroia AT, Donnelly EF, Henry TS, Berry MF, Boiselle PM, Colletti PM et al. ACR Appropriateness Criteria® Intensive Care Unit Patients. J Am Coll Radiol. 2021;18(5):62-72. [Crossref]  [PubMed]
  4. Bentz MR, Primack SL. Intensive care unit imaging. Clin Chest Med. 2015;36(2):219-34. [Crossref]  [PubMed]
  5. Villasana-Gomez G, Toussie D, Kaufman B, Stojanovska J, Moore WH, Azour L, Traube L, Ko JP. Chest Intensive Care Unit Imaging: Pearls and Pitfalls. Clin Chest Med. 2024;45(2):213-235. [Crossref]  [PubMed]
  6. Wechsler RJ, Steiner RM, Kinori I. Monitoring the monitors: the radiology of thoracic catheters, wires, and tubes. Semin Roentgenol. 1988;23(1):61-84. [Crossref]  [PubMed]
  7. Nordin U. The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention. Acta Otolaryngol Suppl. 1977;345:1-71. [PubMed]
  8. Rollins RJ, Tocino I. Early radiographic signs of tracheal rupture. AJR Am J Roentgenol. 1987;148(4):695-8. [Crossref]  [PubMed]
  9. Hosur B, Ahuja CK, Virk RS, Singh P. Unusually dislodged tracheostomy tube with intact airway. BMJ Case Rep. 2020 16;13(7):237195. [Crossref]  [PubMed]  [PMC]
  10. Funaki B. Central venous access: a primer for the diagnostic radiologist. AJR Am J Roentgenol. 2002;179(2):309-18. [Crossref]  [PubMed]
  11. Funaki B. Central venous access: a primer for the diagnostic radiologist. AJR Am J Roentgenol. 2002;179(2):309-18. [Crossref]  [PubMed]
  12. Khan A, McGee WT. Safe Positioning of Central Venous Catheters. J Intensive Care Med. 2022;37(9):1274-1275. [Crossref]  [PubMed]
  13. Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol. 2003;14(5):527-34. [Crossref]  [PubMed]
  14. Ablordeppey EA, Huang W, Holley I, Willman M, Griffey R, Theodoro DL. Clinical Practices in Central Venous Catheter Mechanical Adverse Events. J Intensive Care Med. 2022;37(9):1215-1222. [Crossref]  [PubMed]
  15. Robb CL, Bhalla S, Raptis CA. Subclavian Artery: Anatomic Review and Imaging Evaluation of Abnormalities. Radiographics. 2022;42(7):2149-2165. [Crossref]  [PubMed]
  16. Anderson D, Chen SA, Godoy LA, Brown LM, Cooke DT. Comprehensive Review of Chest Tube Management: A Review. JAMA Surg. 2022;157(3):269-274. [Crossref]  [PubMed]
  17. Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS et al. ACR appropriateness criteria routine chest radiographs in intensive care unit patients. J Am Coll Radiol. 2013;10(3):170-4. [Crossref]  [PubMed]
  18. Toy D, Siegel MD, Rubinowitz AN. Imaging in the Intensive Care Unit. Semin Respir Crit Care Med. 2022;43(6):899-923. [Crossref]  [PubMed]
  19. Kazerooni EA Gross BH. Cardiopulmonary imaging 4th ed. Lines, tubes, and devices. Ella A. Kazerooni, Barry H. Gross, editors. Philadelphia: Lippincott Williams & Wilkins; 2004. 255-293. [Link]
  20. Bussières JS. Iatrogenic pulmonary artery rupture. Curr Opin Anaesthesiol. 2007;20(1):48-52. [Crossref]  [PubMed]
  21. McLoud TC, Putman CE. Radiology of the Swan-Ganz catheter and associated pulmonary complications. Radiology. 1975;116(1):19-22. [Crossref]  [PubMed]
  22. Gale GD, Teasdale SJ, Sanders DE, Bradwell PJ, Russell A, Solaric B et al. Pulmonary atelectasis and other respiratory complications after cardiopulmonary bypass and investigation of aetiological factors. Can Anaesth Soc J. 1979;26(1):15-21. [Crossref]  [PubMed]
  23. Shevland JE, Hirleman MT, Hoang KA, Kealey GP. Lobar collapse in the surgical intensive care unit. Br J Radiol. 1983;56(668):531-4. [Crossref]  [PubMed]
  24. Kreider ME, Lipson DA. Bronchoscopy for atelectasis in the ICU: a case report and review of the literature. Chest. 2003;124(1):344-50. [Crossref]  [PubMed]
  25. Franquet T, Giménez A, Rosón N, Torrubia S, Sabaté JM, Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics. 2000;20(3):673-85. [Crossref]  [PubMed]
  26. Rossi SE, Franquet T, Volpacchio M, Giménez A, Aguilar G. Tree-in-bud pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics. 2005;25(3):789-801. [Crossref]  [PubMed]
  27. Cunnion KM, Weber DJ, Broadhead WE, Hanson LC, Pieper CF, Rutala WA. Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J Respir Crit Care Med. 1996;153(1):158-62. [Crossref]  [PubMed]
  28. Morehead RS, Pinto SJ. Ventilator-associated pneumonia. Arch Intern Med. 2000;160(13):1926-36. [Crossref]  [PubMed]
  29. Winer-Muram HT, Jennings SG, Wunderink RG, Jones CB, Leeper KV Jr. Ventilator-associated Pseudomonas aeruginosa pneumonia: radiographic findings. Radiology. 1995;195(1):247-52. [Crossref]  [PubMed]
  30. Winer-Muram HT, Rubin SA, Ellis JV, Jennings SG, Arheart KL, Wunderink RG et al. Pneumonia and ARDS in patients receiving mechanical ventilation: diagnostic accuracy of chest radiography. Radiology. 1993;188(2):479-85. [Crossref]  [PubMed]
  31. Winer-Muram HT, Steiner RM, Gurney JW, Shah R, Jennings SG, Arheart KL et al. Ventilator-associated pneumonia in patients with adult respiratory distress syndrome: CT evaluation. Radiology. 1998;208(1):193-9. [Crossref]  [PubMed]
  32. Miller PR, Croce MA, Bee TK, Qaisi WG, Smith CP, Collins GL et al. ARDS after pulmonary contusion: accurate measurement of contusion volume identifies high-risk patients. J Trauma. 2001;51(2):223-8; discussion 229-30. [Crossref]  [PubMed]
  33. Gluecker T, Capasso P, Schnyder P, Gudinchet F, Schaller MD, Revelly JP et al. Clinical and radiologic features of pulmonary edema. Radiographics. 1999;19(6):1507-31. [Crossref]  [PubMed]
  34. Aberle DR, Wiener-Kronish JP, Webb WR, Matthay MA. Hydrostatic versus increased permeability pulmonary edema: diagnosis based on radiographic criteria in critically ill patients. Radiology. 1988;168(1):73-9. [Crossref]  [PubMed]
  35. Ichikado K, Suga M, Gushima Y, Johkoh T, Iyonaga K, Yokoyama T et al. Hyperoxia-induced diffuse alveolar damage in pigs: correlation between thin-section CT and histopathologic findings. Radiology. 2000;216(2):531-8. [Crossref]  [PubMed]
  36. Ichikado K, Suga M, Muranaka H, Gushima Y, Miyakawa H, Tsubamoto M et al. Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology. 2006;238(1):321-9. [Crossref]  [PubMed]
  37. Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L et al. Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology. 1999;213(2):545-52. [Crossref]  [PubMed]
  38. Desai SR, Wells AU, Suntharalingam G, Rubens MB, Evans TW, Hansell DM. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: a comparative CT study. Radiology. 2001;218(3):689-93. [Crossref]  [PubMed]
  39. Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams HP. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics. 2003;23(6):1509-19. [Crossref]  [PubMed]
  40. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F et al. Canadian Critical Care Trials Group. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683-93. [Crossref]  [PubMed]
  41. Rivas LA, Fishman JE, Múnera F, Bajayo DE. Multislice CT in thoracic trauma. Radiol Clin North Am. 2003;41(3):599-616. [Crossref]  [PubMed]
  42. Wintermark M, Schnyder P. The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma. Chest. 2001;120(2):543-7. [Crossref]  [PubMed]
  43. Zylak CM, Standen JR, Barnes GR, Zylak CJ. Pneumomediastinum revisited. Radiographics. 2000;20(4):1043-57. [Crossref]  [PubMed]
  44. Müller NL. Imaging of the pleura. Radiology. 1993;186(2):297-309. [Crossref]  [PubMed]
  45. Kuhlman JE, Singha NK. Complex disease of the pleural space: radiographic and CT evaluation. Radiographics. 1997;17(1):63-79. [Crossref]  [PubMed]