Does portable digital chest radiography accurately determine intravascular volume status in adult ICU patients?
Portable digital chest radiography can help differentiate intravascular volume status in ICU patients, with accuracy improved by using objective measurements like vascular pedicle width and cardiothoracic ratio.
OBJECTIVE: To answer the following questions: Can the digital chest roentgenogram (CXR) be used to differentiate patients' volume status? Do clinical data alter radiologists' accuracy in interpreting the digital CXR? DESIGN: Prospective cohort study. SETTING: Nine adult intensive care units of a tertiary care medical center. PATIENTS: One hundred thirty-five consecutive patients with pulmonary artery catheters, of whom 35 were excluded because of unacceptable pulmonary artery occlusion pressure (PAOP) tracings. METHODS: Each patient had a portable, anteroposterior, supine digital CXR. Clinicians evaluated volume status and then measured hemodynamic data within 1 hr of the CXR. Digital CXRs were independently interpreted on two separate occasions (with and without clinical information) by three experienced chest radiologists, and these interpretations were compared with hemodynamic data. RESULTS: Of the 100 patients, 39 had PAOP >18 mm Hg, whereas 61 had PAOP 18 mm Hg from PAOP 70 mm and cardiothoracic ratio >0.55 or by incorporating clinical data.
Ely et al. (Wed,) studied this question.