The implementation of diaphragm ultrasound in routinary care of older adults patients

Diaphragm ultrasound is a non-invasive imaging modality that does not involve ionising radiation, is rapid, reproducible and can be performed at the bedside. It has the potential to accurately detect diaphragmatic dysfunction (7-17) and provides information on the individual's muscular and respiratory fitness: diaphragmatic excursion (DE) values >2 cm during spontaneous breathing are considered normal (22).Several studies and recent systematic reviews have demonstrated the utility of diaphragmatic ultrasound in identifying DD in critically ill patients. In patients with heart failure (HF), reduced DE was associated with poorer exercise tolerance and increased pulmonary pressures (17;89). However, there are no data on elderly patients with HF. In a pilot study, we consecutively enrolled patients aged 65 years or older with a diagnosis of HF who were either hospitalised in our ward or referred to specialised cardio-geriatric outpatient clinics to assess the feasibility of diaphragmatic ultrasound in geriatric patients with HF and to evaluate potential associations between diaphragmatic ultrasound parameters and key HF outcomes. We confirmed the feasibility of diaphragmatic ultrasound in elderly patients with HF. We found an inverse correlation between haemoglobin levels and diaphragmatic excursion, and between respiratory exchange values and diaphragmatic excursion. Importantly, 3 out of 4 patients had a DE below the physiological threshold, with an inverse correlation between DE and increasing age. However, no correlation was found between 30-day mortality or 30-day hospital readmission and DE values. In conclusion, although not related to short-term mortality, we showed that diaphragmatic ultrasound may have a promising application in the context of elderly patients with HF. Follow-up studies with larger sample size and longer observation time are needed to fully exploit its potential.