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    Prone Chest Radiographs: Distinguishing Features and Identification of Support Devices.

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    Author
    Lazarus, Matthew S
    Hossain, Rydhwana
    Villasana, Geraldine M
    Herring, Allison A
    Ye, Kenny
    Jeudy, Jean
    Levsky, Jeffrey M
    White, Charles S
    Haramati, Linda B
    Date
    2022-06-16
    Journal
    Lung
    Publisher
    Springer Nature
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1007/s00408-022-00545-y
    Abstract
    Purpose: Prone position is known to improve acute lung injury, and chest radiographs are often necessary to monitor disease and confirm support device placement. However, there is a paucity of literature regarding radiographs obtained in this position. We evaluated prone radiographs for distinguishing features and ability to identify support devices. Methods: Pairs of prone and supine radiographs obtained during the COVID-19 pandemic were assessed retrospectively. IRB approval and waiver of informed consent were obtained. Radiographs were assessed for imaging adequacy, distinguishing features, and support device identification (endotracheal tube, enteric tube, or central line). Radiographs were reviewed by ≥ 2 cardiothoracic radiologists. Results: Radiographs from 81 patients (63yo ± 13, 30% women) were reviewed. Prone and supine radiographs were comparable for imaging the lung bases (81% vs. 90%, p = 0.35) and apices (93% vs. 94%, p = 1); prone radiographs more frequently had significant rotation (36% vs. 19%, p = 0.021). To identify prone technique, scapula tip located beyond the rib border was 89% sensitive (95%CI 80-95%) and 85% specific (76-92%), and a fundal stomach bubble was 44% sensitive (33-56%) and 90% specific (81-96%). For women, displaced breast shadow was 46% sensitive (26-67%) and 92% specific (73-99%). Prone and supine radiographs each identified > 99% of support devices. Prone exams trended toward increased rate of malpositioned device (12% vs. 6%, p = 0.07). Conclusion: Scapula position reliably distinguishes prone from supine position; fundal stomach bubble or displaced breast shadow is specific for prone position. Prone radiographs reliably identify line and tube position, which is particularly important as prone patients appear at increased risk for malpositioned devices.
    Rights/Terms
    © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
    Keyword
    COVID-19
    Chest radiography
    Critical care
    Prone position
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/19255
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00408-022-00545-y
    Scopus Count
    Collections
    UMB Coronavirus Publications
    UMB Open Access Articles

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