Comparison of Two Chest Radiograph Prescription Strategies in Intensive Care Unit

A Cluster-Randomized Two-Period Cross-Over Study Comparing Routine and on-Demand Prescription of Chest Radiographs in Mechanically Ventilated Adults : the RARE Study

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT00893672

Acronym

RARE

Enrollment

849

Registered

2009-05-06

Start date

2006-12-31

Completion date

2009-04-30

Last updated

2009-05-06

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Intensive Care Units, Patient Care, Quality of Health Care, Ventilation, Mechanical

Keywords

Radiography, Thoracic, Intensive Care Units, Ventilation, mechanical, Matched-Pair Analysis

Brief summary

Current guidelines recommend Routine daily chest radiographs (CXRs) for mechanically ventilated patients in intensive care units (ICUs). However, some ICUs have shifted to an On-demand strategy, in which this CXR is only prescribed if warranted by the patient's status at the morning physical examination. Here the investigators compared Routine and On-demand strategies in 21 French ICUs. The working hypothesis was that CXR prescriptions would fall by at least 20% with the On-demand strategy, with no reduction in quality of care.

Detailed description

Based on a cluster-randomized two-period two-strategies cross-over design, respectively 11 and 10 participating ICUs applied the Routine and On-demand strategies during the first period, each enrolling 20 consecutive patients requiring mechanical ventilation for at least two days. Each ICUs applied then applied the alternative strategy during the second period, again enrolling 20 consecutive patients.

Interventions

None listed

Study design

Observational model

CASE_CROSSOVER

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

* All newly admitted adult patients receiving mechanical ventilation at the time of the morning visit-any day during their ICU stay

Exclusion criteria

* Patients with mechanical ventilation lasting less than 2 days

Design outcomes

Primary

Measure	Time frame
Average number of chest radiographs per patient-day during mechanical ventilation	Every patient-day during mechanical ventilation.

Secondary

Measure	Time frame
Mortality rate in ICU	During the inpatient stay in ICU
Average length of stay	During the inpatient stay in ICU
Average duration of mechanical ventilation	During the inpatient stay in ICU
Number of radiographs with new findings leading to therapeutic or diagnostic interventions	During the inpatient stay in ICU

Countries

France

Outcome results