Conectar
Dyspnea is a common chief complaint leading to emergency department (ED) visits. Multiple conditions may cause or be associated with dyspnoea, including bacterial pneumonia, acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (COPD) or asthma and pulmonary embolism. Each of these diagnoses has a specific treatment recommended by international guidelines. Inappropriate treatment in the ED is more frequent among elderly patients and is independently associated with in-hospital mortality. Point-of-care ultrasound is immediately available at the bedside. Lung and cardiac ultrasound (LuCUS) offers excellent diagnostic accuracy for bacterial pneumonia, AHF and COPD exacerbations, even in elderly patients. The primary objective of the LUC REED trial is to evaluate the impact of a LuCUS-guided strategy versus standard care on reducing inappropriate treatment of dyspnoea in elderly ED patients.
The LUC REED trial is a prospective, interventional, multicentre, stepped-wedge randomised controlled trial designed to assess the superiority of a LuCUS-guided strategy over standard care in ensuring treatment appropriateness for dyspnoea in elderly ED patients. The study will include 504 patients over 2 years. Patients aged >65 years presenting with acute dyspnoea and signs of severity (respiratory rate ≥22 or SpO2
Ethics final approval was obtained from the Institutional Review Board of France—Est IV on 4 April 2025 (2024-A01678-39). Results will be published in peer-reviewed international journals.
Acute circulatory failure plays a major role in the development of sepsis-related organ dysfunction. Current ‘bundles’ of the Surviving Sepsis Campaign (SSC) include the administration of a fluid loading of 30 mL/kg in the presence of hypotension within the first hour of sepsis identification. The impact of haemodynamic assessment using echocardiography at the early phase of management of septic patients in the Emergency Department (ED) on patient-centred outcomes is unknown.
This is a two-parallel arm randomised trial with blinded assessment comparing early haemodynamic assessment using transthoracic echocardiography aimed at guiding therapeutic management to standard of care according to current SSC recommendations in septic patients during initial management in 13 French EDs. Patients with suspected or documented infection and a qualifying quick Sequential Organ Failure Assessment (qSOFA) score (haemodynamic criterion required: systolic blood pressure≤100 mm Hg) will be 1:1 randomised after 500 mL of fluid loading initiation. In the intervention group, echocardiography will allow identifying the haemodynamic profile at the origin of sepsis-induced circulatory failure and monitoring the efficacy and tolerance of fluid resuscitation, or of any other therapeutic intervention according to a predefined therapeutic algorithm. The control group will receive conventional 30 mL/kg fluid resuscitation (unless pulmonary venous congestion) according to SSC recommendations. Primary outcome will be the course of organ dysfunction assessed by the crude change in the modified SOFA score between baseline and 24 hours after randomisation. Secondary outcomes will be the nature of therapeutic interventions resulting from echocardiography (fluid loading, early initiation of vasopressor support or inotrope), the prevalence of the different haemodynamic profiles, the evolution of lactatemia, the safety of the initial therapeutic, the proportion of patients who develop secondarily septic shock, the orientation of patients after ED discharge and both day 7 and in-hospital mortality. We plan to randomise 312 patients.
Approved by the Ethics Committee CPP Ouest V on 18 January 2021 (ref: 20/075-2-20.10.16.57638). The dissemination plan includes presentations at scientific conferences and publication of results in a peer-reviewed journal.
Dissemination of results following clinical trials and community-based research provides value to participants and communities beyond the intent of the primary study. Organizations participating in multi-site research may see similar benefits if local results are shared; however, it is not standard practice. Evaluation of the impact of results sharing in multi-site research is needed.
To assess the benefits of organizational participation in a multi-site pediatric pain study when results were shared, identify how sites applied local results, and the outcomes of participation, including subsequent improvement efforts and scholarship.
Following data collection for a 12-hospital multi-site study, site research teams shared their experiences collecting the data and lessons learned. All sites received a packet with overall results, their local results, and an interpretation guide. 4 years later, the sites were surveyed about initiatives that were undertaken because of the primary study.
Following data collection, 10 of 12 sites described unanticipated benefits of participation, including identifying gaps and strengths of documentation, generation of new practice questions, and identification of new opportunities for improvement. Seven sites answered the follow-up survey 4 years later. Most sites (n = 6, 85.7%) used their data to inform multiple practice changes (M = 2.8, SD 0.75), including changes in pain documentation (n = 5, 83.3%), assessment (n = 4, 66.7%), policy (n = 4, 66.7%), and treatments (n = 4, 66.7%). Five sites reported an average of 2.4 (SD 1.14) additional activities stimulated by participation, but not directly due to data. Three sites used results for American Nurses Credentialing Center Magnet Recognition applications.
When multi-site investigators provide local data, organizations see long-term benefits, including new collaborations, quality improvement efforts, and research. Additional exploration of collaborative strategies between investigators and practice settings in multi-site research is needed for pediatric pain management and beyond.
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