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Master Thesis

Apport de l’échographie portable pour l’évaluation de la volémie en Gériatrie

Abstract : Background: clinical assessment of volume status is a daily challenge in geriatric care, due to poor sensitivity and specificity of classical signs. Standard transthoracic echocardiography (TTE) is used to estimate volume status, but access to this technique may be limited. Right atrial pressure can be estimated from inferior vena cava (IVC) diameter and collapsibility index (degree of inspiratory collapse) measured by hand-carried ultrasound (HCU). These pocket-size devices enable quick bed-side cost-effective evaluation by geriatricians. Objective: to compare volume status assessment after clinical examination and biology interpretation on the one hand, and after HCU on the other hand, by a geriatrician. Methods: patients hospitalized in University Hospital Geriatric acute care units from November 2020 to June 2021, with suspicion of volume status imbalance (overload or dehydration), were included in this prospective observational study. After clinical examination and biology interpretation, the IVC diameter and collapsibility index were assessed from the sub-costal view, by a geriatrician trained by a cardiologist during two half-days. Results: in 38 patients, mean age was 89 years old and 63% were women. Clinical and biological volume status assessment was different from HCU in 20 patients (53%, IC 95%: 35-67%). %). The most frequent discordance (n=13) was clinical-biological suspicion of overload in patients with euvolemia according to HCU. This led to diagnostic changes in 13 patients (34%, 95% CI: 17-37%), and to 13 (34%, 95% CI: 17-37%) significant therapeutic changes (stopping or starting drugs). Patients with a different volume status between clinical-biological and HCU assessments were younger (p = 0.0098), more often had a history of COPD (p = 0.001), presented less often with weight variation (p = 0.032), or jugular vein distension (p = 0.024), more often had a compliant IVC (p = 0.010) and an "euvolemic status according to HCU" (p = 0.002). Conclusion: HCU performed during hospitalization in acute geriatric care for a suspicion of volume status imbalance provide assessments that differs from clinical-biological assessment in about 50% of cases. HCU could be a useful tool in geriatric departments to help diagnose overload or dehydration, to guide therapeutic adjustments in older patients, especially during acute heart failure.
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https://dumas.ccsd.cnrs.fr/dumas-03482097
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Submitted on : Wednesday, December 15, 2021 - 4:48:21 PM
Last modification on : Friday, December 17, 2021 - 3:47:06 AM
Long-term archiving on: : Wednesday, March 16, 2022 - 7:30:11 PM

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  • HAL Id : dumas-03482097, version 1

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Mademoiselle Mathilde Faillé. Apport de l’échographie portable pour l’évaluation de la volémie en Gériatrie. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03482097⟩

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