Hacquin Arthur, Putot Sophie, Barben Jérémy, Chagué Frédéric, Zeller Marianne, Cottin Yves, Manckoundia Patrick, Putot Alain
Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, Dijon University Hospital, Dijon, France.
Department of Cardiology, Dijon University Hospital, Dijon, France.
ESC Heart Fail. 2020 Dec;7(6):4424-4428. doi: 10.1002/ehf2.13017. Epub 2020 Oct 13.
In the older population, acute heart failure is a frequent, life-threatening complication of COVID-19 that requires urgent specific care. We aimed to explore the impact of point-of-care chest ultrasound (CUS) use in older bedridden inpatients during the COVID-19 pandemic as a tool to distinguish between cardiogenic pulmonary oedema and isolated viral pneumonia-related dyspnoea.
This prospective series included 16 patients aged 75 or older, hospitalized for acute dyspnoea in an acute geriatric unit of a university hospital and testing positive for a SARS-Cov2 infection. We collected demographic characteristics, medical history, biological screening, clinical symptoms, CUS findings (n = 16) and chest CT-scan conclusions (n = 14). Mean age was 89 years (77-97). All patients presented asthenia and dyspnoea, 56% complained of coughing and diarrhoea, and 50% had fever. Acute heart failure was clinically suspected in seven patients. At CUS, evidence of heart failure was confirmed in three patients (including one without clinical suspicion); interstitial syndrome was confirmed in 12 patients on CUS vs. 9 patients with CT.
In older patients with COVID-19 and acute dyspnoea, the use of point-of-care CUS allowed the clinician to quickly rule out heart failure in nearly half of suspected cases while easily identifying virus-related interstitial syndrome. The use of CUS appears to be suitable for the rapid bedside investigation of dyspnoea in older patients, particularly in the context of the COVID-19 pandemic.
在老年人群中，急性心力衰竭是新型冠状病毒肺炎（COVID-19）常见的、危及生命的并发症，需要紧急的特殊护理。我们旨在探讨在COVID-19大流行期间，即时床旁胸部超声（CUS）在老年卧床住院患者中的应用，作为区分心源性肺水肿和单纯病毒性肺炎相关呼吸困难的工具。
本前瞻性系列研究纳入了16例年龄在75岁及以上的患者，他们因急性呼吸困难在一家大学医院的急性老年病科住院，且SARS-CoV-2感染检测呈阳性。我们收集了人口统计学特征、病史、生物学检查、临床症状、CUS检查结果（n = 16）和胸部CT扫描结论（n = 14）。平均年龄为89岁（77 - 97岁）。所有患者均出现乏力和呼吸困难，56%的患者主诉咳嗽和腹泻，50%的患者发热。7例患者临床上怀疑有急性心力衰竭。在CUS检查中，3例患者确诊为心力衰竭（包括1例无临床怀疑的患者）；CUS检查确诊12例患者存在间质综合征，而CT检查确诊9例。
对于患有COVID-19且急性呼吸困难的老年患者，使用即时床旁CUS可使临床医生在近一半的疑似病例中快速排除心力衰竭，同时轻松识别病毒相关的间质综合征。CUS的应用似乎适用于对老年患者呼吸困难进行快速床旁检查，尤其是在COVID-19大流行的背景下。
