Diaphragm Response in Elderly for Acute Monitoring

N/ANot Yet RecruitingNCT07132268

Centre Hospitalier de Bethune145 enrolled

Overview

Acute dyspnea is a common cause of emergency department admissions among elderly patients. Acute respiratory failure is often multifactorial and requires rapid and reliable evaluation. Currently, management relies on clinical, biological, and radiological assessments, but diaphragmatic ultrasound could provide an additional tool for real-time respiratory function evaluation. This study aims to integrate this non-invasive technology into the initial assessment of patients to improve care pathways. Hypothesis : Diaphragmatic ultrasound enables reliable assessment of respiratory function and can predict the need for mechanical ventilation.

Study Type

OBSERVATIONAL

Enrollment

145

Conditions

Acute Dyspnea Acute Respiratory Failure Diaphragmatic Ultrasound

Eligibility

Sex: ALLMin age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged ≥ 75 years * Emergency admission for acute dyspnea * Requiring an emergency ultrsoung. Exclusion Criteria: * Acute respiratory distress requiring immediate invasive or non-invasive ventilation * Respiratory rate ≥ 25 breaths/min, and/or SpO2 ≤ 90% on room air, and/or PaO2 ≤ 60 mmHg * Known diaphragmatic paralysis * Patients with degenerative neuromuscular disease * State of shock: systolic blood pressure \< 90 mmHg and/or mean arterial pressure \< 65 mmHg and/or presence of skin mottling and/or CTR \> 3s * Lactate levels \> 2 mmol/L * Hypercapnic respiratory acidosis (pH \< 7.38 and PaCO2 \> 45 mmHg) * Dyspnea due to metabolic acidosis (e.g., diabetic ketoacidosis, renal failure) * Dyspnea of traumatic origin * Refusal to participate or inability to provide informed consent * Patients deprived of liberty * Patients under guardianship or curatorship

Locations (9)

Centre Hospitalier Victor Dupouy

Argenteuil, France

Centre Hospitalier de Béthune

Béthune, France

Centre Hospitalier de Douai

Douai, France

Centre Hospitalier Emile Roux

Le Puy-en-Velay, France

Centre Hospitalier Sud Ile-de-France

Melun, France

Centre Hospitalier de Roubaix

Roubaix, France

Centre Hospitalier de Saint-Lô

Saint-Lô, France

Centre Hospitalier de Tourcoing

Tourcoing, France

Centre Hospitalier de Valenciennes

Valenciennes, France

Outcomes

Primary Outcomes

Occurrence of a severe acute respiratory event within 7 days of admission

* Placement on invasive mechanical ventilation (intubation) or non invasive ventilation (NIV, high-flow oxygen therapy), * Respiratory death, confirmed by an independent adjudication committee blinded to the ultrasound results. Explanatory variable: The presence of impaired diaphragmatic function at admission will be defined by: * a Tdi (tele-inspiratory thickness) \<10%, and/or * a diaphragmatic excursion \<10 mm.

Time frame: WITHIN 7 DAYS OF ADMISSION

Secondary Outcomes

Measurement of diaphragmatic excursion AND Etiology of acute dyspnea

To study the association between diaphragmatic excursion curve parameters (EDR, inspiratory time, expiratory time, etc.) and the etiology of acute dyspnea in patients aged 75 years and older admitted for acute dyspnea

Time frame: within 7 days

To evaluate the contribution of diaphragmatic ultrasound to the NEWS2 score performed on admission in predicting the occurrence of acute respiratory distress within 7 days.

The discriminatory power of the NEWS2 score in predicting the occurrence of acute respiratory distress, the discriminatory power of the NEWS2 score combined with impaired diaphragmatic function on admission ultrasound. NEWS 2 : The higher the score, the greater the risk of clinical deterioration. 0-4 : low risk Score of 3 in any individual parameter : low-medium 5-6 : moderate risk \> or = 7 : high risk