Use of Lung Ultrasound in Reducing Radiation Exposure in Neonates with Respiratory Distress: A Quality Management Project

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2024-02, Vol.60 (2), p.308
• Main Authors: Nemes, Alexandra Floriana, Toma, Adrian Ioan, Dima, Vlad, Serboiu, Sorina Crenguta, Necula, Andreea Ioana, Stoiciu, Roxana, Ulmeanu, Alexandru Ioan, Marinescu, Andreea, Ulmeanu, Coriolan
• Format: Article
• Language: English
• Subjects: Birth weight; chest radiographs; Continuous positive airway pressure; Data collection; Edema; Gestational age; High-Frequency Ventilation; Hospitals; Humans; Infant, Newborn; Infants (Newborn); Intensive care; Lung - diagnostic imaging; Lung diseases; lung ultrasound; Neonatal care; neonatal intensive care unit; Neonatology; Patient safety; Pneumonia; Quality control; Quality management; Radiation; Radiation Exposure - prevention & control; Respiration, Artificial - methods; Respiratory Distress Syndrome; Surfactants; Ultrasonic imaging; Ventilators; X-rays
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60020308

Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; = 0.03) or 2021 (58.1% vs. 34.5%; = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; = 0.032) or 2021 (16.3% vs. 44.8%; = 0.008). The mean radiation dose decreased from 5.89 Gy × cm in 2021 to 3.76 Gy × cm in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), a