Diaphragm Response in Elderly for Acute Monitoring

Acute dyspnea is a common cause of emergency department admissions among elderly patients. Acute respiratory failure is often multifactorial and requires rapid and reliable evaluation. Currently, management relies on clinical, biological, and radiological assessments, but diaphragmatic ultrasound could provide an additional tool for real-time respiratory function evaluation. This study aims to integrate this non-invasive technology into the initial assessment of patients to improve care pathways. Hypothesis : Diaphragmatic ultrasound enables reliable assessment of respiratory function and can predict the need for mechanical ventilation.

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Key information

Conditions

Acute Dyspnea Acute Respiratory Failure Diaphragmatic Ultrasound

Age range

75 year and older

Sex eligibility

All sexes

Study type

Observational

Primary location

Centre Hospitalier Victor Dupouy, Argenteuil, France

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Patients aged ≥ 75 years
Emergency admission for acute dyspnea
Requiring an emergency ultrsoung.

Exclusion criteria

Acute respiratory distress requiring immediate invasive or non-invasive ventilation
Respiratory rate ≥ 25 breaths/min, and/or SpO2 ≤ 90% on room air, and/or PaO2 ≤ 60 mmHg
Known diaphragmatic paralysis
Patients with degenerative neuromuscular disease
State of shock: systolic blood pressure < 90 mmHg and/or mean arterial pressure < 65 mmHg and/or presence of skin mottling and/or CTR > 3s
Lactate levels > 2 mmol/L
Hypercapnic respiratory acidosis (pH < 7.38 and PaCO2 > 45 mmHg)
Dyspnea due to metabolic acidosis (e.g., diabetic ketoacidosis, renal failure)
Dyspnea of traumatic origin
Refusal to participate or inability to provide informed consent
Patients deprived of liberty
Patients under guardianship or curatorship

Treatment and study plan

Primary outcomes

Occurrence of a severe acute respiratory event within 7 days of admission

Time frame: WITHIN 7 DAYS OF ADMISSION
- Placement on invasive mechanical ventilation (intubation) or non invasive ventilation (NIV, high-flow oxygen therapy),
- Respiratory death, confirmed by an independent adjudication committee blinded to the ultrasound results.
Explanatory variable: The presence of impaired diaphragmatic function at admission will be defined by:
- a Tdi (tele-inspiratory thickness) <10%, and/or
- a diaphragmatic excursion <10 mm.

Secondary outcomes

Measurement of diaphragmatic excursion AND Etiology of acute dyspnea

Time frame: within 7 days

To study the association between diaphragmatic excursion curve parameters (EDR, inspiratory time, expiratory time, etc.) and the etiology of acute dyspnea in patients aged 75 years and older admitted for acute dyspnea
To evaluate the contribution of diaphragmatic ultrasound to the NEWS2 score performed on admission in predicting the occurrence of acute respiratory distress within 7 days.

Time frame: within 7 days

The discriminatory power of the NEWS2 score in predicting the occurrence of acute respiratory distress, the discriminatory power of the NEWS2 score combined with impaired diaphragmatic function on admission ultrasound.

NEWS 2 : The higher the score, the greater the risk of clinical deterioration. 0-4 : low risk Score of 3 in any individual parameter : low-medium 5-6 : moderate risk

> or = 7 : high risk

Study contacts

Contact information is provided by the study sponsor or research team.

Tristan CARRIE, Doctor

CONTACT

[email protected]

03.21.64.70.84

Sponsors and collaborators

Lead sponsor

Centre Hospitalier de Bethune

Network

Registry information

Official study title

Using Diaphragmatic Ultrasound to Predict Acute Respiratory Distress (ARD) in Patients Aged 75 and Over Admitted to the Emergency Department for Acute Dyspnea : Prospective Multicenter Study.

Acronym: DREAM

Important dates

Study start: 2026
Primary completion: 2028
Study completion: 2028
First posted: Aug 20, 2025
Registry last updated: May 6, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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