Longitudinal assessment of pulmonary morphological patterns using structured serial chest radiography in mechanically ventilated ICU patients.

Background

Portable chest radiography is routinely available in mechanically ventilated ICU patients, yet serial findings are rarely standardized. We evaluated whether a structured morphological classification of serial chest radiographs could describe early radiographic evolution during invasive mechanical ventilation (IMV) and explored associations with clinical outcomes.

Methods

Single-centre retrospective cohort of 57 adults receiving IMV ≥48 h in the ICU of Hospital General IESS Babahoyo, Ecuador (2018-2019). Radiographs from Days 1-5 of IMV were classified into 13 predefined predominant morphological categories; radiological change was defined as any modification of the predominant pattern relative to baseline. IMV duration, ICU length of stay, and mortality were analysed using an exploratory logistic regression model.

Results

Radiographs were available for 57 patients on Days 1-2, 46 on Day 3, 39 on Day 4, and 34 on Day 5. Normal predominant patterns decreased from 52.6% at baseline to 14.7% on Day 5, while alveolar patterns increased from 10.5% to 35.3%. Thirty-two patients (56.1%) had documented radiological pattern change, first identified at a median of Day 2. Patients with documented change had longer IMV duration (5.5 vs. 3 days; p < 0.001) and ICU stay (8 vs. 3 days; p < 0.001). In the exploratory adjusted model, IMV duration was associated with documented change (adjusted OR 1.30, 95% CI 1.0-1.6; p = 0.018).

Conclusions

Structured serial chest radiography converted routine ICU images into comparable longitudinal morphological variables. Documented radiological change was common and frequently early; its association with longer IMV duration should be interpreted as concurrent and exploratory. Prospective multicentre studies are needed.