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Guidelines for Reading and Interpreting Chest Radiographs in Patients Receiving Mechanical Ventilation

Published online by Cambridge University Press:  21 June 2016

Helen T. Winer-Muram ,
Sanford A. Rubin ,
Massimo Miniati  and
James V. Ellis
Helen T. Winer-Muram
Affiliation:
Department of Radiology, The University of Tennessee, Memphis Department of Radiology, University of Texas Medical Branch, Galveston CNR Institute of Clinical Physiology, Pisa, Italy Department of Radiology, Veterans Affairs Medical Center Memphis
Sanford A. Rubin
Affiliation:
Department of Radiology, The University of Tennessee, Memphis Department of Radiology, University of Texas Medical Branch, Galveston CNR Institute of Clinical Physiology, Pisa, Italy Department of Radiology, Veterans Affairs Medical Center Memphis
Massimo Miniati
Affiliation:
Department of Radiology, The University of Tennessee, Memphis Department of Radiology, University of Texas Medical Branch, Galveston CNR Institute of Clinical Physiology, Pisa, Italy Department of Radiology, Veterans Affairs Medical Center Memphis
James V. Ellis
Affiliation:
Department of Radiology, The University of Tennessee, Memphis Department of Radiology, University of Texas Medical Branch, Galveston CNR Institute of Clinical Physiology, Pisa, Italy Department of Radiology, Veterans Affairs Medical Center Memphis
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Extract

The technical limitations of portable chest radiography, the lack of lateral radiographs, and the difficulties in positioning critically ill patients hinder the radiologic diagnosis of pneumonia, especially in patients receiving mechanicalventilation (MV). Optimally, anteroposterior (AP) portable radiographs are obtained utilizing high kilovoltage (120 to 130 kV), short exposure time, and fast filmscreen combinations to increase radiographic latitude and decrease motion unsharpness. Whenever possible, constant source-tofilm and source-to-patient distance should be maintained to allow for proper assessment of changes in mediastinal or cardiac diameters. Multiple factors should be recorded, including radiographic technique, focus-film distance, kilovoltage (kv), milliampere (mA), patient position, and ventilator settings for positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP).

Type
Proceedings of the First International Consensus Conference on the Clinical Investigation of Ventilator-Associated Pneumonia
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 11 , November 1992 , pp. 650 - 656
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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References

1. Goodman, LR. Cardiopulmonary disorders in the critically ill. In: Goodman, LR, Putnam, CE, eds. Intensive Care Radiology: Imaging of the Critically III. 2nd ed. Philadelphia, Pa: WB Saunders; 1983:61–113.Google Scholar
2. Goodman, LR Putnam, CE. Diagnostic imaging in acute cardi opulmonary disease. Clin Chest Med. 1984;5:247–264.Google Scholar
3. Turner, AF. Interpretation of the conventional chest x-ray in the critically ill and injured. In: Shoemaker, WC, Thompson, WL, Holbrook, PR, eds. Textbook of Critical Care. 2nd ed. Philadelphia: WB Saunders; 1984:230–241.Google Scholar
4. Wiener, MD, Garay, SM, Leitman, BS, et al. Imaging of the intensive care unit patient. Clin Chest Med. 1991;12:169–198.Google Scholar
5. Guidelines for the Use of ILO International Classification of Radiographs of Pneumoconioses. Revised edition. 1980. Occupational Safety and Health Series No. 22 (Rev).Google Scholar
6. Milne, ENC, Pistolesi, M, Miniati, M, et al. The radiologic distinction of cardiogenic and noncardiogenic edema. AJR. 1985;144:879–894.Google Scholar
7. Pistolesi, M, Miniati, M, Milne, ENC, et al. The chest roentgenogram in pulmonary edema. Clin Chest Med. 1985;6:315–344.Google Scholar
8. Aberle, DR Brown, K. Radiologic considerations in the adult respiratory distress syndrome. Clin Chest Med. 1990;11:737–754.Google Scholar
9. Andrews, CP, Coalson, JJ, Smith, JD, et al. Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury. Chest. 1981;80:254–258.Google Scholar
10. Peters, JI, Bell, RC, Prihoda, TJ, et al. Clinical determinants of abnormalities in pulmonary functions in survivors of the adult respiratory distress syndrome. Am Rev Respir Dis. 1989; 139:1163–1168.Google Scholar
11. Coalson, JJ. Pathophysiologic features of respiratory distress in the infant and adult. In Shoemaker, WC, Thompson, WL, Holbrook, PR, eds. Textbook of Critical Care. 2nd ed. Philadelphia, Pa: WB Saunders; 1984:344–354.Google Scholar
12. Wunderink, RG, Woldenberg, LS, Zeiss, J, et al. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101:458–463.Google Scholar
13. Bryant, LR, Mobin-Uddin, K, Dillon, ML, et al. Misdiagnosis of pneumonia in patients needing mechanical ventilation. Arch Surg. 1973;106:286–288.Google Scholar
14. Salata, RA, Lederman, MM, Shlaes, DM, et al. Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis. 1987;135:426–432.Google Scholar
15. Winer-Muram, HT Ellis, JV. Diagnostic imaging of pneumonia and its complications in the critically ill patient. Prob Crit Care. In press.Google Scholar
16. Marini, JJ, Pierson, DJ Hudson, LD. Acute lobar atelectasis: a prospective comparison of fiberoptic bronchoscopy and respi ratory therapy. Am Rev Respir Dis. 1979;119:971–978.Google Scholar
17. Fagon, JY, Chastre, J, Hance, AJ, et al. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis. 1988;138:110–116.Google Scholar
18. Bombino, M, Gattinoni, L, Pesenti, A, et al. The value of portable chest roentgenography in adult respiratory distress syndrome: comparison with computed tomography. Chest. 1991;100:762–769.Google Scholar
19. Liddell, FDK. Radiological assessment of small pneumoconiotic opacities. Br J Ind Med. 1977;34:85–94.Google Scholar
20. Eysen, GE. Methods of Assessing Radiographic Progression in the Pneumoconioses. Montreal: McGill University; 1975.Google Scholar
21. Meduri, GU. Ventilator associated pneumonia in patients with respiratory failure: a diagnostic approach. Chest. 1990;97:1208–1219.Google Scholar
22. McHugh, TJ, Forrester, JS, Adler, L, et al. Pulmonary vascular congestion in acute myocardial infarction: hemodynamic and radiologic correlations. Ann Intern Med. 1972;76:29.Google Scholar
23. Morgan, PW Goodman, LR. Pulmonary edema and adult respi ratory distress syndrome. Rad Clin NAm. 1991;29:943–963.Google Scholar
24. Herman, PG, Khan, A, Kallman, CE, et al. Limited correlation of left ventricular end diastolic pressure with radiographic assessment of pulmonary hemodynamics. Radiology. 1990;174:721–724.Google Scholar
25. Kostuk, W, Barr, JW, Simon, AL, et al. Correlations between the chest film and hemodynamics in acute myocardial infarction. Circulation. 1973;48:624–631.Google Scholar
26. Ravin, CE. Pulmonary vascularity: radiographic considerations. J Thorac Imag. 1988;3:1–13.Google Scholar
27. Maunder, RJ, Shuman, WP, McHugh, JW, et al. Preservation of normal lung regions in the adult respiratory distress syndrome: analysis by computed tomography. JAMA. 1986;255:2463–2465.Google Scholar
28. Gattinoni, L, Pesenti, A, Torresin, A, et al. Adult respiratory distress syndrome profiles by computed tomography. J Thorac Imag. 1986;1:25–30.Google Scholar
29. Gattinoni, L, Pesenti, A, Avalli, L, et al. Pressure-volume curve of total respiratory system in acute respiratory failure: computed tomographic scan study. Am Rev Respir Dis. 1987;136:730–736.Google Scholar
30. Gattinoni, L, Pesenti, A, Baglioni, S, et al. Inflammatory pulmonary edema and positive end-expiratory pressure: correlations between imaging and physiologic studies. J Thorac Imag. 1988;3:59–64.Google Scholar
31. Halperin, BD, Feeley, TW, Mihm, FG, et al. Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest. 1985;88:649–652.Google Scholar