Utility of postintubation chest radiographs in the intensive care unit

Objective: To determine the clinical usefulness of immediate (stat) chest radiographs after endotracheal intubation when performed by experienced critical care personnel.

      Patients and methods:
      This was a prospective study. Endotracheal intubations in an
			11-bed intensive care unit and a nine-bed intermediate intensive care unit were
			included. After intubations were performed by an experienced critical care
			operator, that individual recorded demographic and procedural data, and
			predicted radiographic findings on a data collection sheet. Experience at
			intubation was stratified into four levels of lifetime experience: fewer than
			10 procedures, 10-20 procedures, 20-50 procedures, and more than 50 procedures.
			Radiographic findings evaluated included endotracheal tube position and
			procedure-related complications. The postintubation chest radiograph was then
			reviewed and the actual findings were also recorded.
    
    
      Results:
      A total of 101 evaluable intubations were recorded, two of which
			were predicted to show tube malposition. Actual radiographic findings revealed
			10 malpositions, three of which were too high and seven were too low (one at
			the level of the carina). A single witnessed aspiration that occurred during
			intubation was not radiographically apparent until 24 h later. Only the tube
			positioned at the carina was felt to be of acute clinical significance or to
			place the patient at any acute risk.
    
    
      Conclusions:
      The incidence of endotracheal tube malposition after intubation
			was underestimated. However, when performed by experienced critical care
			personnel, acutely significant malpositions were rare (one out of 101
			intubations). We conclude that, in the absence of specific pulmonary
			complications, endotracheal intubations performed by experienced operators may
			be followed by routine, rather than 'stat' chest radiographs.