Advancing healthcare through thoracic ultrasound research in older patients

Abstract

This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency–urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.

The Multidisciplinary Mobile Unit (MMU) Program Bringing Hospital Specialist Geriatric Competencies at Home: A Feasible Alternative to Admission in Older Patients with Urgent Complaints

“…Our data suggest that the MMU model is a feasible and effective strategy to manage urgent clinical complaints of older patients directly at their own homes, especially related to respiratory illness, avoiding hospital referral for diagnostic or treatment purposes. Point-ofcare ultrasonography, in particular, seems to be of paramount importance for facilitating the diagnostic process outside the hospital [16,17]. Thoracic ultrasound has proven diagnostic effectiveness, particularly in older frail patients, where traditional first-level exams, such as chest X-ray, may lack sensitivity [21].…”

“…Geriatric multi-site ultrasound is a cornerstone of the MMU consultation [16,17]. In many situations, the integration of clinical data with ultrasound findings allows one to better focus the diagnosis and quickly initiate an appropriate treatment.…”

“…In many situations, the integration of clinical data with ultrasound findings allows one to better focus the diagnosis and quickly initiate an appropriate treatment. This is particularly true for respiratory diseases, where ultrasound, in the hands of expert operators, has diagnostic capacity in many cases similar to chest computed tomography [16,17].…”

Diaphragm Ultrasound in Different Clinical Scenarios: A Review with a Focus on Older Patients

“…Diaphragm ultrasound should also be integrated with thoracic ultrasonography, in the assessment of both acute and chronic patients, as recently suggested by a position paper of the Research Group on Thoracic Ultrasound in the Older Patient by the Italian Society of Geriatrics and Gerontology [ 199 ]. Multi-site ultrasound assessment is generally able to improve the clinical management of geriatric patients, and this is particularly true for the frailer ones, who generally do not take advantage of traditional diagnostic examinations.…”

Predicting In-Hospital Acute Heart Failure Worsening in the Oldest Old: Insights from Point-of-Care Ultrasound

“…In our study, the odds of adverse outcomes increased by 15% for every 1-unit increase in the total PEFs and reduced by 10% for every 1-unit increase in IVC collapsibility. Even if its role in the diagnosis of acute heart failure is well recognized, the prognostic relevance of pleural effusion in older patients has not been investigated systematically [25]. Nonetheless, several studies have successfully linked its presence to an increased risk of mortality [26][27][28].…”