The Problem of Daily Imaging in the Intensive Care Unit: When You Care So Much It Hurts

As the economic and clinical fragilities of the world make themselves known during the coronavirus disease 2019 (COVID-19) pandemic, the importance of resource use rises to the forefront of health care professionals' minds. The authors look on the compelling example by Maley and Stevens regarding a case where routine diagnostic examinations turned into a near-miss event. They argue that not only are seemingly innocuous care practices, such as daily chest radiographs (CXRs), expensive and inefficient, but also that significant underappreciated harms, including inappropriate interventions based on inaccurate results, abound. A systematic review of 9 studies also revealed no harm associated with a restrictive CXR strategy. A study of an intervention to reduce routine CXRs in a cardiac surgery ICU showed similar results: nearly 11% of patients had unexpected, clinically relevant findings discovered on routine CXRs,4 although clinical outcomes were not affected. Furthermore, the bottom line seems to be that it is possible to reduce routine CXRs in the ICU, and although a few findings might be missed, it does not seem to alter patients' outcomes.