Hand-carried ultrasound for volaemia assessment in older adults: A prospective observational study

Clinical assessment of volaemia is a daily challenge in geriatric care. Access to standard transthoracic echocardiography may be limited. Right atrial pressure is influenced by volaemia and can be estimated from inferior vena cava (IVC) diameter and collapsibility measured by hand-carried ultrasound (HCU). These pocket-size devices enable rapid bedside evaluation.

To determine the added value of HCU performed by geriatricians in addition to clinical and biological data for assessing volaemia (hypovolaemia, euvolaemia or hypervolaemia).

This single-centre prospective observational cross-sectional study included patients hospitalized in geriatric care units whose extracellular volume status was in doubt, based on clinical and biological data. IVC diameter and collapsibility index were assessed by geriatricians using HCU.

Overall, 102 patients were included (median [interquartile range] age 89 [84-94] years, 58% women). Volaemia based on clinical and biological data was different from that assessed by HCU in 54 patients (53%, 95% confidence interval [CI] 43-63%; Cohen's κ=0.15). This discordance was associated with the absence of clinically detectable jugular vein distension (P=0.014). The most frequent discordance (n=37) was clinical-biological suspicion of hypervolaemia in euvolaemic patients according to HCU. This led to a therapeutic impact (stopping or starting drugs) in 36 patients (35%, 95% CI 26-44%).

HCU performed during hospitalization for a suspicion of volaemia imbalance provides an assessment that differs from clinical-biological assessment in approximately 50% of cases. HCU could be a useful tool in geriatric care units to improve the diagnosis and management of volaemia.