Clinical Research Directory

Quantification of Systemic Congestion by Ultrasound As a Predictor of Weaning Failure From Mechanical Ventilation

Mechanical ventilation is an essential, life-saving therapy in the ICU, allowing critically ill patients to rest and recover. Transitioning patients back to spontaneous breathing-known as weaning-is clinically challenging. The first attempt, the Spontaneous Breathing Trial (SBT), fails in 10-30% of cases. Identifying the mechanisms behind failure is crucial, as unsuccessful weaning prolongs ICU stay and increases the risk of reintubation, which worsens prognosis. The SCOUT study aims to improve prediction and management of weaning failure. The main objective of the study is to evaluate whether a specific ultrasound-based method, the Venous Excess Ultrasound Score (VExUS), can predict failure of weaning from mechanical ventilation. A key pathophysiological factor is systemic venous congestion. When a patient initiates an SBT, the increased respiratory effort shifts venous return and may precipitate cardiovascular decompensation with pulmonary fluid accumulation, termed weaning-induced pulmonary edema (WIPO). Notably, this may occur even in patients without known cardiac disease. Detecting clinically relevant congestion before SBT is difficult. Fluid balance and body weight are imprecise, physical examination lacks sensitivity, and biomarkers such as NT-proBNP have limited predictive capacity. VExUS offers a promising, non-invasive approach by directly assessing venous flow patterns in major veins (inferior vena cava, hepatic, portal, and renal veins), providing an estimation of systemic venous pressure and congestion. The central hypothesis is that elevated VExUS grades prior to SBT will identify patients at high risk of failure, enabling proactive optimization and potentially improving outcomes. SCOUT is designed as a prospective, multicenter, observational study. Standard clinical management of mechanical ventilation and weaning remains unchanged. After informed consent, baseline data will be obtained immediately before SBT, including vital signs, ventilator parameters, blood sampling, and three non-invasive ultrasound assessments: cardiac, pulmonary, and VExUS. During the 30-120-minute SBT, the patient breathes with reduced ventilatory support while their clinical tolerance is evaluated. At the end of the SBT, selected measurements are repeated. Weaning failure is defined as: early termination of SBT due to intolerance, need for invasive or non-invasive ventilation within 48 h after extubation, or death within 48 h. Data are anonymized and stored securely (REDCap) in compliance with Spanish and EU data protection regulations. The study is low-risk and provides no direct individual benefit, but may benefit future ICU patients by improving weaning strategies and prognostication.

Lung Ultrasound for the Detection of Volume Overload in Patients With Severe Preeclampsia

This research aims to evaluate the usefulness of lung ultrasound (LUS) for detecting and monitoring fluid overload in patients with severe preeclampsia. Severe preeclampsia is a leading cause of maternal death and illness worldwide, often causing fluid buildup that can lead to a serious complication called pulmonary edema, especially after delivery. The study will be a prospective, longitudinal observational study with a diagnostic validation component. It will involve patients with a diagnosis of severe preeclampsia who meet specific inclusion criteria. Each participant will undergo a clinical exam and a lung ultrasound, which will assess eight zones of the lungs. The total number of B-lines-a sign of interstitial edema-will be documented. Data will be collected at three key times: upon admission, in the immediate postpartum period (within 24 hours of delivery), and 7-10 days postpartum. The results from the LUS will be compared to clinical signs like shortness of breath, rapid breathing, crackling sounds in the lungs, and oxygen saturation levels. The expected impact of this research is to provide evidence that LUS is a valuable, non-invasive, and accessible tool for the early detection of pulmonary congestion in patients with severe preeclampsia. This could lead to improved clinical decision-making and a reduction in maternal respiratory complications.

Comparison of Respiratory Support for Acute Pulmonary Edema

This study is a retrospective study. The demographic and vital signs of patients with acute pulmonary edema are retrospectively collected to compare the prognosis of patients after receiving different respiratory support.

Grasshopper: a Novel Clinical Dashboard for Radiologists

Does a radiology clinical dashboard increase radiologist use of specific reporting language for chest X-rays (CXRs) and thereby decrease rates of unnecessary Emergency Department (ED) prescriptions and follow-up imaging?

Epidemiological Assessment of Technical Diving Accidents in Mainland France and Factors Predictive of Severity (TEKCare)

This retrospective study aims at an epidemiological description of the clinical presentation of medical problems in technical diving. It assess anthropometric data, diving experience and dive planification, clinical presentation, treatment received and pronostic to understand specificity of this community.