Clinical Research Directory

Hemodynamic Effects of Intravenous Paracetamol in Patients Undergoing Emergency Laparotomy

Emergency laparotomy is a high-risk procedure often performed in patients with severe physiological derangements due to sepsis, making perioperative management challenging. Although multimodal analgesia is essential, options are often limited by factors such as hemodynamic instability, renal dysfunction, and coagulopathy. Intravenous paracetamol is commonly recommended for perioperative analgesia because of its opioid-sparing effect, but evidence suggests it may cause hypotension through peripheral vasodilation, particularly in critically ill patients. Most data on this effect come from observational studies, and evidence regarding its intraoperative hemodynamic impact remains limited.

Preoperative Hemoglobin and Acute Kidney Injury in Emergency Surgery

Optimization of hemoglobin levels for organ perfusion is essential, especially in critically ill patients. Although anemia is associated with severe organ failure, especially in coronary artery disease, the effects of blood transfusion or various interventions to increase hemoglobin levels on outcomes continue to be debated. The effects of hemoglobin levels in emergency surgery patients on the development of postoperative AKI have been investigated in a small number of studies in the literature, and clear results have not yet been reported. This study was designed to evaluate the effect of hemoglobin levels on the development of AKI after adjustment for known predictive factors.

Acute Preoperative Pain and Chronic Post-surgical Pain in Emergency Surgery

Studies evaluating postoperative pain as a risk factor for CPSP are almost exclusively carried out in the context of scheduled surgery. As a result, the preoperative pain studied as a risk factor for chronicity is essentially a state of pain that has persisted for several weeks or even several months. In emergency surgeries, patients are subject to acute preoperative pain of varying intensity and the duration of which may vary by a few days. A few studies have highlighted the intensity of acute preoperative pain as a factor favouring moderate to severe postoperative pain. At this point, no study has addressed the long-term consequences of this intense preoperative pain the emergency context. An evaluation in the field of emergency surgery, where the preoperative pain is often intense and limited in time, would enable us to identify more precisely the impact of acute pain on the incidence of CPSP. The investigators are hypothesising that the occurrence of CPSP at 3 months in patients undergoing emergency orthopaedic or abdominal surgery is associated with acute preoperative pain.

Irrisept in Emergency General Surgery Patients

This is a single institution, randomized study conducted to determine if irrigation with Irrisept in emergency general surgery patients results in lower surgical site infections compared to normal saline irrigation.

Prognosis of Veno-Venous Extracorporeal Membrane Oxygenation in Emergency Thoracic Surgery

Veno-vneous extracorporeal membrane oxygenation (VV-ECMO) is an established support strategy for acute respiratory failure, but its role in the perioperative management of emergency thoracic surgery remains poorly defined. This retrospective, multicenter, observational study aims to assess the clinical outcomes and prognostic factors in this high-risk population. Patients undergoing emergency thoracic procedures requiring VV-ECMO will be compared to a control cohort of patients treated with VV-ECMO for medical respiratory failure. Data will be collected from two French academic centers (CHU Amiens-Picardie and CHU Dijon).

Risk Stratification for Abdominal Emergency Surgery: a Cohort Study

The goal of this retrospective observational study is to identify risk factors of unwanted outcomes (in-hospital morbidity and mortality) among patients undergoing emergency abdominal surgery.

Establishment of Emergency Surgery Triage and Checklist Management System

The goal of this observational study is to develop and test a system for managing emergency surgery patients at Beijing Union Medical College Hospital. The main questions it aims to answer are: What information is necessary for effective patient triage and handovers between the emergency department, anesthesia, and ICU for surgical patients? How effective and feasible is a standardized handover process in improving patient outcomes and safety? Participants will: Be observed and have their handovers documented to identify key information required. Participate in implementing a new handover checklist and triage system. Researchers will compare the periods before and after implementing the new system to see if it: Reduces missed critical information during handovers. Decreases pre-surgery waiting times for critically ill patients. Improves overall patient safety and outcomes, including reducing postoperative complications, mortality rates, length of hospital stay, and medical costs.

Aspiration Risk Assessment by Gastric Ultrasound in eMErgency Surgery and ANesThetic Decision-making: The ARGUMENT Study

Pulmonary aspiration of gastric contents is a serious patient safety problem accounting for 50% of anesthesia-related mortality. The risk is higher in patients undergoing emergency surgery as the gastric content is uncertain which poses a challenge to anesthetic decision-making. Standard clinical assessment to identify at-risk patients primarily relies on preoperative fasting guidelines and is not adequate for patients undergoing emergency surgeries. Point-of-care gastric ultrasound (GUS) has emerged as an accurate bedside tool providing information regarding the type and volume of gastric contents. When GUS was added to standard clinical assessment, anesthetic management plan changed in 71% of adult elective and 37% of pediatric emergency surgical procedures. Such data is lacking in adult patients undergoing emergency surgeries. The investigators propose a multicentre mixed-method study to evaluate the impact of GUS on aspiration risk assessment and subsequent Anesthetic Plan before emergency surgeries. The evidence from this study will improve patient safety by accurately identifying patients at risk of aspiration and tailoring anesthetic techniques and airway management to prevent pulmonary aspiration in patients undergoing emergency surgeries.