Congestive Heart Failure Clinical Trial
Official title:
The Incidence of Significant Clinical Findings Using Focused Ultrasound Examination for the Heart, Lungs and Abdomen in Elderly Patients Before Emergent Surgery
The purpose of this study is to determine whether a focused ultrasound examination for the heart, lungs and abdomen, preformed by a trained anesthesiologist, can reveal significant clinical findings in elderly patients before emergent surgery.
Emergent orthopedic and urological surgeries in the elderly population are characterized by
high incidence of chronic diseases of the target population on one hand, and the time factor
which limits the possibility to properly assess the preoperative condition on the other
hand.
Therefore, anesthesiologist often perform these procedures such as hip replacement with
insufficient data as compared to an elective case.
In Israel, a hip fracture must be operated on within 18 hours. This type of fracture is
common to the elderly population who naturally suffer more from chronic diseases that might
influence the management of anesthesia. Due to the emergent nature of the procedures
involved, the patients are often operated on with only basic preoperative assessment such as
ECG, chest x-ray and blood tests.
A more elaborated assessment, such as a valid echocardiography , evaluation of pleural
effusion or the presence of ascites are often impossible to acquire due to inaccessibility
of the echo lab (high burden, missing qualified personal ) or the availability of operation
theater.
This is an observational pilot study in which the ability of a focused, bedside preoperative
ultrasound examination preformed by a qualified anesthesiologist to expose significant
clinical data will be evaluated.
Sample size: 30 patient. Male and female over the age 65. The examination will cover the
heart (eg. volemic status, global systolic function, existence of severe valvular pathology,
pericardial effusion), lungs (eg. pleural effusion, atelectasis, pneumothorax ) and abdomen
( e.g ascites ). It will be preformed at the patient bed using the VIVID5S General Electric
device. All fields will be examined using the low frequency cardiac probe.
The data will be documented and saved electronically by the main investigator. All recorded
ultrasound examination will be saved and coded with a number (no patient details).
All data collected will be validated by a physician experienced in the field. Any mismatch
between the anesthesiologist records to the validated data will be documented.
Clinically significant findings will be documented and transferred (after validation) to the
anesthesiologist performing the anesthesia (only senior anesthesiologist ).
On the following day, the anesthesiologist will document :
1. Any changes in anesthetic management due to the examination findings
2. Subjective report regarding the utility of the examination
Anesthetic changes and subjective report will be graphically documented. The
anesthesiologist preforming the examination underwent the necessary qualifications to
preform the exam. In any case, the preoperative examination and operation will not be held
by the same anesthesiologist.
Patient enrollment to the study will be preformed at the ward, E.R or preoperative hall. It
must be emphasized that in any case the performance of the operation will not be detained by
the examination.
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Observational Model: Case-Only, Time Perspective: Prospective
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