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According to a study published in the November issue of the Lancet, the adoption of an on-demand strategy in preference to a routine strategy to decrease use of chest radiographs in mechanically ventilated patients without a reduction in patients' quality of care or safety.

Present guidelines recommend routine daily chest radiographs for mechanically ventilated patients in intensive care units. However, some units use an on-demand strategy, in which chest radiographs are done only if warranted by the patient's clinical status. The study aimed to compare routine and on-demand strategies to establish which strategy is more efficient and effective for optimum patient care.

The cluster-randomised, open-label crossover study, conducted by Dr Gilles Hejblum and colleagues, included patients from 21 intensive care units at 18 hospitals in France. Each unit used a routine or an on-demand strategy for prescription of chest radiographs during the first of two treatment periods and then the alternative strategy in the second period. Each treatment period lasted for the time taken for enrolment and study of 20 consecutive patients per intensive care unit; patients were monitored until discharge from the unit or for up to 30 days' mechanical ventilation, whichever was first.

Overall, 424 patients had 4607 routine chest radiographs (mean per patient-day of mechanical ventilation 1•09, 95% CI 1•05—1•14), and 425 had 3148 on-demand chest radiographs (mean 0•75, 0•67—0•83), which corresponded to a reduction of 32% (95% CI 25—38) with the on-demand strategy (p<0•0001). Based on the study findings, the authors strongly support the adoption of an on-demand strategy in preference to a routine strategy.