[Study with thoracic and abdominal spiral CT in intensive care unit patients]

The severe clinical conditions of intensive care unit patients need frequent imaging studies to detect the pathologic changes in the patients' situation and to plan the correct therapeutic management. The yield of bedside plain radiography is often not diagnostic but moving the patients to the radiology department could affect their clinical conditions. Conventional CT is difficult to perform in these patients because they need continuous assistance and cannot cooperate during the diagnostic examination.

The authors examined with Spiral CT 46 unconscious patients in poor clinical conditions who presented a variety of pulmonary and abdominal diseases. Thirty coma patients were submitted to bedside chest radiography and then to Spiral CT because there was disagreement between the radiographic and the clinical findings. Sixteen patients with abdominal conditions underwent Spiral Ct, 11 of them after bedside US. The chest and abdomen were examined with Spiral CT in 2/16 patients and the abdomen only in 5 cases; twenty-two of 46 patients were under assisted ventilation. During all the Spiral CT studies, the patients had their arms along the body. Spiral CT results were compared with those of bedside chest radiography in 30 cases and with those of bedside abdominal US in 11 patients.

Spiral CT is a fast examination technique with no major artifacts which can be used safely also in unconscious patients. It confirmed a variety of pathologic conditions which may be misdiagnosed by conventional chest radiography, which improves the care of these patients. Bedside plain radiography is limited by several factors depending on the patient (no cooperation, variable respiration, still decubitus), the examination technique (X-ray projection, exposure, poor diagnostic yield), and the anatomical region of interest (mediastinal vessels). Even though our technical standard for conventional radiography was high, Spiral CT was better in detecting parenchymal consolidation and pleural effusion, a missed pneumothorax or thromboembolic disease. We always performed Spiral CT when the clinical findings did not match the results of bedside plain radiography. Moving the patients was very easy because the intensive care unit in our hospital is in the same building as the radiology department and there were dedicated devices supporting the coma patients.