Department of Internal Medicine, University Hospital Ostrava, Ostrava, Czech Republic.
Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024 Sep;168(3):256-261. doi: 10.5507/bp.2023.038. Epub 2023 Oct 3.
Acutely ill older patients frequently suffer not only from their acute disease, but also polymorbidity and frailty. Dehydration is another typical symptom, usually occurring in its both forms: low-intake dehydration and volume depletion. POCUS is goal-directed bedside ultrasound examination and several studies refer to its positive impact on hydration assessment. The aim of our study was to determine whether POCUS might influence (de)hydration diagnostics and/or treatments in older patients with acute illness.
We randomized 120 acutely ill patients, aged ≥65 years, into POCUS and non-POCUS groups. All participants underwent routine laboratory tests, including haematocrit, serum and urine osmolality, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio, and C-reactive protein (CRP). POCUS was performed twice during the first two days to determine chest and abdominal status, with inferior vena cava (IVC) measurements. Length of hospital stay (HL) and consumption of infused fluids (CIF) was evaluated too. Data were analysed with exploratory methods and appropriate statistics.
Among all participants, the serum osmolality significantly correlated with age, BUN, creatinine and CIF. HL correlated with CRP and CIF. No significant correlations between IVC and other followed parameters were found. The POCUS group consumed significantly less infused fluids than the non-POCUS group, what could be influenced by POCUS examination of defined body compartments.
Dehydration is a common feature in older individuals and its diagnostics is rather complicated. The role of POCUS in assessing hydration status remains unclear. However, our study showed, that ultrasound assessment provides next important information for comprehensive understanding of clinical status in older patients and can be beneficial for optimizing the treatment strategy, including fluid management decisions.
患有急性病的老年患者不仅经常受到急性疾病的影响，还经常受到多种合并症和虚弱的影响。脱水是另一种常见的症状，通常有两种表现形式：低摄入性脱水和容量不足。POCUS 是一种有针对性的床旁超声检查，有几项研究表明它对评估患者的脱水情况有积极影响。我们的研究目的是确定 POCUS 是否会影响急性病老年患者的（脱）水诊断和/或治疗。
我们将 120 名年龄≥65 岁的急性病患者随机分为 POCUS 组和非 POCUS 组。所有参与者都接受了常规实验室检查，包括血细胞比容、血清和尿液渗透压、血尿素氮（BUN）、肌酐、BUN/肌酐比值和 C 反应蛋白（CRP）。在头两天，我们对所有患者进行了两次 POCUS 检查，以确定胸部和腹部情况，并测量下腔静脉（IVC）。还评估了住院时间（HL）和输注液体量（CIF）。使用探索性方法和适当的统计方法对数据进行了分析。
在所有参与者中，血清渗透压与年龄、BUN、肌酐和 CIF 显著相关。HL 与 CRP 和 CIF 相关。IVC 与其他随访参数之间没有显著相关性。POCUS 组的输注液体量明显少于非 POCUS 组，这可能与 POCUS 对特定身体部位的检查有关。
脱水是老年人的常见特征，其诊断较为复杂。POCUS 在评估水合状态中的作用仍不清楚。然而，我们的研究表明，超声评估为全面了解老年患者的临床状况提供了重要信息，并有助于优化治疗策略，包括液体管理决策。
