Dyspnea, Respiratory Distress Syndrome
Conditions
Keywords
Elderly, Point-of-Care Ultrasound, Respiratory Distress Syndrom, Dyspnea
Brief summary
Prospective trial to evaluate the impact on the initial therapeutic inadequacy of a management strategy for acute dyspnea in the elderly based on the use of lung and cardiac ultrasonography.
Detailed description
Acute dyspnea is a frequent and serious reason of admission in Emergency Department (ED), with a one-month mortality close to 16%. It is difficult to diagnose in the initial assessment phase since the cause of this symptom can vary (cardiological, pulmonary, infectious, etc.) and the symptoms can be misleading. This difficulty in diagnosing delays the implementation of appropriate therapeutic management even as the timeliness of management is associated with a reduction in mortality. These issues are particularly important in the elderly. Lung and cardiac ultrasonography performed by the emergency physician, immediately available at the patient's bedside, could reduce the diagnostic and therefore therapeutic delay. However, the impact of a diagnostic strategy based on lung and cardiac ultrasonography in dyspneic elderly subjects has not been evaluated. Patients will be randomized in two groups : standard of care or clinical ultrasound group. Treatments initiated in Emergency Department (ED) will be noted to be compared to final diagnosis.
Interventions
DIAGNOSTIC_TESTdiagnostic strategy based on lung and cardiac ultrasonography
cardiopulmonary ultrasound performed by the emergency physician, immediately at patient's bed
Sponsors
University Hospital, Toulouse
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Outcomes Assessor)
Masking description
Diagnostic classification and therapeutic adequacy or inadequacy will be established by expert appraisal of the files by 2 experts (a cardiologist and a pulmonologist ) blind to the results of the clinical ultrasound and the the other expert.
Intervention model description
stepped-wedge randomized
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Eligible patients will be aged over 65 years, affiliated with the French social security system, and presenting to the ED with acute dyspnea (onset \<14 days) accompanied by severity signs before or at triage (respiratory rate ≥22 and SpO2 \<92% on room air). The enrolling emergency physician (EP) must be the patient's treating physician and must be trained in LuCUS. Written informed consent from the patient or their legal representative is required for inclusion
Exclusion criteria
dyspnea secondary to thoracic trauma, dyspnea clearly related to COVID-19, known pulmonary fibrosis or lung cancer, prior administration of specific treatment for dyspnea before inclusion, immediate need for endotracheal intubation, patients identified as being at end-of-life, and individuals under legal guardianship or deprived of liberty.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| therapeutic inadequacy | Hour 1 | therapeutic inadequacy between initiated emergency treatments and the final diagnosis made by expert opinion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| correct diagnosis | emergency department discharge (up to hour 4) | correct diagnosis at the emergency department discharge (compared with final diagnosis made by expert opinion) |
| duration of emergency department stay | emergency department discharge (up to hour 4) | duration in emergency department (in hours) |
| Post-emergency hospital stay | Day 30 | duration in Post-emergency hospital department: in medicine/surgery/obstetrics or follow-up and rehabilitation care (in days) |
| Number of days alive outside hospital between D0 and D30 | Day 30 | Number of days alive outside hospital between D0 and D30 |
| Care cost | Day 30 | Care cost - Direct and indirect medical cost looking at French social security spendings for patients |
Countries
France
Contacts
Primary ContactManon Hebrard
Outcome results
None listed