Abstract
Background
The diagnosis of dehydration in older patients remains a challenge because clinical and laboratory signs are unspecific. The use of B‑Mode ultrasound of the inferior vena cava is proposed to aid in the diagnosis but data concerning diagnostic efficacy of bedside ultrasound are lacking.
Methods
In this study 78 patients ≥65 years old referred to the emergency unit of a university hospital and identified as being dehydrated by applying clinical signs were compared with a reference of 121 patients. The diameter of the inferior vena cava (IVC) was assessed by ultrasound while compressing the IVC during an inspiratory maneuver and the minimum and maximum diameter in M‑Mode.
Results
Significant differences were found concerning compressibility, variability of the diameter assessed by M‑Mode and the diameter during an inspiratory maneuver of the IVC (<0.001); however, a receiver operator characteristics (ROC) showed only moderate values for diagnostic efficacy for all these parameters where the best result was found for the inspiratory maneuver (Area under the curve [AUC] = 0.73). To reach a specificity of 0.8 to diagnose dehydration, a cut-off value of ≤0.4 cm for IVC diameter was suitable.
Conclusion
Ultrasound of the IVC can easily be applied in a bedside setting and may be helpful in identifying dehydration in older patients; however, this remains challenging and a synopsis covering clinical and technical data is indispensable.
Zusammenfassung
Hintergrund
Die Diagnose Dehydratation ist nach wie vor gerade bei älteren Menschen eine Herausforderung, da die zur Verfügung stehenden klinischen und laborchemischen Zeichen relativ unspezifisch sind. Der B‑Mode-Ultraschall der V. cava inferior wird in diesem Zusammenhang al eine zusätzliche Hilfe propagiert, ist aber bezüglich der diagnostischen Effektivität in typischen klinischen Situationen nicht hinreichend untersucht.
Fragestellung
Lassen sich ausgehend von einer klinischen Synopse Parameter aus dem Ultraschall der V. cava inferior in einem Bed-side-Ansatz in der Notaufnahme gewinnen und können diese zur Diagnostik der Dehydratation beitragen?
Material und Methoden
Insgesamt 78 Patienten (65 Jahre und älter), die in einer zentralen Notaufnahme eines Universitätskrankenhauses vorgestellt wurden und die anhand klinischer Zeichen als dehydriert eingeschätzt worden waren, wurden mit einer Kontrollgruppe von 121 Patienten ohne Zeichen einer Dehydratation verglichen. Verschiedene Diameter der V. cava inferior wurden mittels Ultraschall erfasst. Dazu zählten auch der Diameter unter Kompression, derjenige während eines Inspirationsmanövers sowie der maximale und minimale Durchmesser im M‑Mode.
Ergebnisse
Die verschiedenen Diameter der V. cava inferior konnten in den meisten Fällen mittels Ultraschall erhoben werden. Signifikante Unterschiede wurden bezüglich Kompressibilität der V. cava inferior, der Variabilität im M‑Mode und des Diameters während des Inspirationsmanövers gefunden IVC (<0,001). Eine ROC(„receiver-operator characteristics“)-Analyse dieser Parameter zeigte allerdings lediglich moderate Ergebnisse, wobei das beste Ergebnis für den Diameter während des Inspirationsmanövers aufgezeigt werden konnte („Area under the curve“ [AUC] = 0.73). Um mit einer Spezifität von 0,8 die Diagnose einer Dehydratation stellen zu können, erwies sich ein Cut-off-Wert von ≤0.4 cm für den IVC-Diameter während des Inspirationsmanövers als geeignet.
Diskussion
Ultraschall der V. cava inferior kann in der Notaufnahme meist angewendet werden und somit die Diagnostik einer Dehydratation bei älteren Patienten unterstützen. Er ersetzt jedoch nicht komplett die klinische Beurteilung. Die Diagnose Dehydratation bleibt insgesamt komplex sowie eine klinische Synopse aus unterschiedlichen Parametern prinzipiell unverzichtbar. Hier kann Ultraschall aber durchaus einen Beitrag leisten.
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Acknowledgements
The authors thank J. Grüttner, T. Walter and the entire staff of the emergency department of Universitätsmedizin Mannheim for their valuable support and advice.
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H. Diederich and H. Burkhardt declare that they have no competing interests.
All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Diederich, H., Burkhardt, H. Diagnostic efficacy of bedside ultrasound to detect dehydration in older patients attending an emergency care unit. Z Gerontol Geriat 54, 130–135 (2021). https://doi.org/10.1007/s00391-020-01711-8
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DOI: https://doi.org/10.1007/s00391-020-01711-8