Geriatric Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
Unit of Geriatrics and Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio-Medico University and Teaching Hospital, Rome, Italy.
J Am Med Dir Assoc. 2020 Apr;21(4):447-454.e6. doi: 10.1016/j.jamda.2019.06.018. Epub 2019 Aug 6.
To investigate the current evidence on the use of point-of-care chest ultrasonography in older patients and geriatric settings and present the current state of the art of chest ultrasound applications.
Special article based on a literature review with narrative analyses and expert clinical knowledge.
All studies performed in a geriatric setting were included. Observational and intervention studies and meta-analyses including participants aged ≥70 years were also considered, even if not specifically focused on a geriatric setting.
Data on participant characteristics, diagnostic accuracy of chest ultrasonography, and outcomes were collected for each considered study. Data were analyzed and discussed with a particular focus on the possible applications and advantages of chest ultrasonography in geriatric medicine, underlining the possible areas of future research.
We found only 5 studies on the diagnostic accuracy and prognostic relevance of chest ultrasonography in geriatrics. However, several studies performed in emergency departments, intensive care units, and internal medicine wards included a large number of participants ≥70 years old; they suggest that chest ultrasonography may represent a valid aid to the diagnostics of acute dyspnea, pneumonia, acute heart failure, pneumothorax, and pleural diseases, with an accuracy in some cases superior to standard x-rays, especially when mobility limitation is present. Diaphragm ultrasonography may also represent a valid tool to guide mechanical ventilation weaning in older patients with acute respiratory failure.
Chest ultrasonography may represent a valid bedside diagnostic aid to the management of acute respiratory diseases in older patients. However, specific evidence is lacking for geriatric patients. Future research will need to focus on defining the reference standards and the diagnostic accuracy for older patients with frailty and multimorbidity, cost-efficacy and cost-effectiveness of the technique, its impact for clinical outcomes, and role for follow-up in the post-acute care.
调查即时床旁胸部超声检查在老年患者和老年环境中的应用现状，并介绍胸部超声应用的最新技术。
基于文献回顾的专题文章，结合叙述性分析和临床专业知识。
纳入在老年环境中进行的所有研究。还考虑了观察性和干预性研究以及包含≥70 岁患者的荟萃分析，即使这些研究并非专门针对老年环境。
为每个研究收集了参与者特征、胸部超声诊断准确性和结局的数据。对数据进行了分析和讨论，特别关注胸部超声在老年医学中的可能应用和优势，强调了未来研究的可能领域。
我们仅发现了 5 项关于老年患者胸部超声诊断准确性和预后相关性的研究。然而，一些在急诊科、重症监护病房和内科病房进行的研究纳入了大量≥70 岁的患者；这些研究表明，胸部超声检查可能是急性呼吸困难、肺炎、急性心力衰竭、气胸和胸膜疾病诊断的有效辅助手段，在某些情况下，其准确性优于标准 X 光检查，尤其是在存在活动受限的情况下。膈肌超声检查也可能是指导老年急性呼吸衰竭患者机械通气撤机的有效工具。
胸部超声检查可能是老年患者急性呼吸疾病管理的有效床边诊断辅助手段。然而，针对老年患者，具体证据尚缺乏。未来的研究需要集中于确定衰弱和多病共存的老年患者的参考标准和诊断准确性、该技术的成本效益和成本效果、对临床结局的影响以及在急性后护理阶段的随访作用。
