Chest Trauma

Researchers are evaluating postoperative pain in patients undergoing minimally invasive pulmonary lobectomy and/or segmentectomy for resectable non-small cell lung cancer (NSCLC). The study compares the use of small-bore (16F) chest drains to the standard large-bore (24F) chest drains. It aims to determine if smaller chest tubes and earlier removal can reduce pain and improve recovery without compromising safety. This is a prospective randomized controlled trial conducted at a single center. Participants are assigned to one of four groups: small-bore (16F) chest tubes removed early (2 to 6 hours after surgery), small-bore tubes removed at standard time (1 day post-op), large-bore (24F) tubes removed early, or large-bore tubes removed at standard time. The study monitors safety and feasibility of early chest drain removal and compares effects of tube size and timing on postoperative outcomes. During the study, pain levels are assessed multiple times within the first three days after surgery, at discharge, and during follow-ups at 30 and 180 days. Researchers also track analgesic use, duration of drainage, fluid output, hospital stay length, complications, rehospitalization, mortality, chronic pain, and quality of life. Participants can expect detailed monitoring and evaluations throughout hospitalization and at follow-up visits up to six months after surgery.

This research aims to evaluate interventions to support family members who act as surrogate decision makers for critically ill patients in Intensive Care Units (ICUs). These surrogates often face intense grief and stress that can affect their mental health and the quality of decisions made for their loved ones near end-of-life. The study focuses on reducing symptoms of prolonged grief disorder (PGD), post-traumatic stress disorder (PTSD), and related emotional challenges through a psychological intervention called EMPOWER. The study compares two approaches: the EMPOWER intervention, which is a brief, cognitive-behavioral and acceptance-based treatment delivered by trained mental health professionals, and a Supportive Conversation (SC) that provides empathetic support without specific skill-building. EMPOWER includes six 15-minute modules and two booster phone sessions, totaling about 90 minutes plus follow-ups, while the Supportive Conversation matches this time with supportive interaction and follow-up calls. Participants are assessed up to four times before and after the intervention within three months. Participants, who are surrogate decision makers of ICU patients near end-of-life, will complete assessments on grief, PTSD, depression, regret, anxiety, and distress before the intervention, immediately after, and at 3 and 12 months follow-up. The study also includes interviews with some participants to better understand the intervention's effects and contextual factors during the COVID-19 pandemic. The primary outcomes focus on changes in grief and PTSD symptoms over twelve months, with safety and mental health monitored throughout the study period.

This research aims to compare chronic pain outcomes following different robotic-assisted thoracic surgery (RATS) techniques used for pulmonary resections in patients with lung tumors. These surgeries are important for treating lung neoplasms, with approaches tailored to tumor size and location. Minimally invasive surgeries like video-assisted thoracic surgery (VATS) have reduced acute pain but chronic pain remains a concern. The study evaluates three RATS methods: the transthoracic approach (RATS-TT), the "out of cage" technique (RATS-OTC) that avoids intercostal nerve injury, and a hybrid method (RATS-TTH) used at CHUM. Participants will have pulmonary resection surgery using one of the three RATS techniques. RATS-TT uses intercostal trocars for instruments and specimen removal, RATS-OTC avoids intercostal access by using subcostal or subxiphoid ports, and RATS-TTH combines intercostal instrument access with out-of-cage specimen extraction to reduce nerve trauma. The study observes pain at 3 and 6 months post-surgery to assess chronic pain incidence. These approaches are compared to understand their effects on persistent pain after surgery. Participants will be followed up at 3 and 6 months after surgery to assess persistent postoperative pain, including chest pain at rest or with coughing. Pain will be evaluated by patient response, and additional assessments include neuropathic pain components, overall recovery, analgesic use, opioid consumption, hospital stay length, residual pain intensity, and presence of dysesthesia. The study collects data on these outcomes to better understand long-term pain following different surgical techniques for lung tumor removal.

This observational study aims to understand how force feedback instruments are useful during surgeries performed with the da Vinci 5 robotic system. It focuses on procedures such as inguinal and ventral hernia repairs, colorectal, thoracic, gynecologic surgeries, and partial nephrectomy. The study is designed to gather information on how these instruments perform during robotic-assisted surgery. Participants will undergo multi-port robotic-assisted surgery using the da Vinci 5 system equipped with force feedback instruments, which provide tactile sensations. The study observes surgeries planned as primary procedures with these instruments, without altering the treatment. There is no experimental drug or placebo involved, as this is an observational study conducted after the devices have been marketed. During the study, researchers will measure the force applied to tissues by the force feedback instruments during surgery and evaluate how useful these instruments are during specific steps of the procedure before patient discharge. Participants will be followed up as per the study protocol to ensure data quality. The total participation time varies depending on the surgical procedure and follow-up schedule.

Researchers are evaluating the accuracy of the New Injury Severity Score (NISS) in predicting mortality and other outcomes in patients with blunt trauma admitted to the Emergency Department of Kadhimiya Educational Hospital in Iraq. This prospective observational study aims to understand how well NISS predicts death, the need for intensive care, and the length of hospital stay among trauma patients, addressing a research gap in resource-limited healthcare settings. Participants admitted with blunt trauma will be assessed using the NISS score within the first six hours of arrival to the emergency department to ensure accurate trauma evaluation. Their clinical progress, including mortality, need for intensive care, hospital stay duration, and surgical interventions, will be monitored throughout hospitalization, averaging six days. During the study, patients' anatomical injuries and physiological parameters will be documented to calculate the NISS. Researchers will track outcomes such as in-hospital mortality and length of hospitalization, with follow-ups at days 7 and 30 after discharge. This study will provide valuable information on the usefulness of NISS in managing blunt trauma in Iraq and contribute to improving trauma care protocols.

Researchers are collecting and analyzing data from patients with Acute Subdural Hematoma to better understand the effects of different surgical treatments. This observational study focuses on comparing standard surgical options such as burr hole trephination, craniotomy, decompressive craniectomy, and a newer technique called Middle Meningeal Artery embolization. The goal is to evaluate how these procedures impact survival outcomes in trauma patients. The study gathers information retrospectively from the Methodist Dallas Medical Center Trauma Registry. Data collected includes patient demographics, diagnosis codes, injury details, surgical procedures, complications, laboratory results, and outcomes such as discharge status and mortality. This comprehensive data collection allows researchers to observe real-world treatment effects without altering patient care. Participants are trauma patients aged 18 years or older who have an acute subdural hematoma diagnosed by brain CT or MRI within 72 hours of injury. Researchers will review medical records and imaging to collect relevant information. The primary measurement is the total number of study sites and subjects over five years. There is no active treatment or intervention; instead, the study monitors and analyzes existing clinical data to improve understanding of surgical options and patient outcomes.

Researchers are investigating the effects of combining Proprioceptive Neuromuscular Facilitation (PNF) with cardiorespiratory training (CRT) on individuals who have hemiparesis following a stroke. This condition impacts limb function as well as the trunk and abdomen, reducing physical activity. The study aims to evaluate how PNF and CRT together might improve quality of life, gait, respiratory and motor functions, and other health measures in people with stroke-related hemiparesis. Forty participants post-stroke will be randomly assigned to one of four groups: lower limbs CRT with PNF, lower limbs CRT with respiration exercises, upper limbs CRT with PNF, or upper limbs CRT with respiration exercises. Each group will undergo 20 sessions of therapy lasting one hour each, including stretching, rest, and 40 minutes of aerobic treatment using a cycle ergometer for either the upper or lower limbs. PNF patterns and breathing exercises are performed in various positions to enhance trunk function. Participants will be assessed before the treatment, immediately after 20 sessions (about two months), and one month after completing therapy. Assessments include quality of life scales, gait analysis, oxygen consumption, respiratory muscle strength, diaphragm thickness, and rib cage volume measurements. Monitoring of heart rate, blood pressure, oxygen saturation, and perceived exertion will support safety and adherence throughout the program.

This research aims to evaluate how well a computer-based system called LUNIT can interpret chest X-rays to identify lung contusions in patients with blunt chest injuries. The study compares LUNIT's readings to those of radiologists and uses chest high-resolution CT scans as the gold standard. Lung injuries from chest trauma can lead to serious complications and require careful monitoring to prevent respiratory failure. The study is observational and retrospective, involving patients who visited the Emergency Department of IRCCS AOU of Bologna between June 2014 and June 2024. Included patients had blunt thoracic trauma and underwent both a standard chest X-ray and a chest HRCT within 48 hours. Radiologists will analyze the chest X-rays with and without the support of the LUNIT software, allowing comparison of the system's ability to detect lung contusions against standard interpretations. Participants' existing medical images and reports will be reviewed without altering their care. The study measures how accurately LUNIT detects lung contusions compared to radiologist readings, using chest HRCT as the reference. This evaluation will help determine if LUNIT can reduce the need for CT scans, lowering radiation exposure and potentially speeding up emergency care management. The study is expected to last about one year until mid-2025.

Researchers are studying ways to detect, measure, and treat air leaks that happen during lung surgery. The goal is to reduce complications, problems after surgery, and hospital stays for patients who have lung tissue removed. This research uses human lungs removed during transplant surgeries to create a stable and effective lung model for testing these methods. The lungs from transplant patients will be kept in a special acrylic box at 37 degrees Celsius and mechanically ventilated through an inserted tube to simulate breathing. Different procedures will be performed, including creating air leaks by stapling or cutting the lung tissue. A novel bio-adhesive sealant will be applied to these leaks to test its ability to seal them. The seal will be checked using gas and water techniques, and air leaks will be measured using an automated drainage system. Participants will not be directly involved since the study uses removed lungs. Researchers will perform multiple procedures on the lungs, collect tissue samples, and take images to find the best model settings. Lung tissue temperature, blood vessel pressure, and other factors will be monitored. The main outcomes measured are detecting and localizing air leaks and reducing their size by 80% with the bio sealant. The study follows a 48-month timeline for these assessments, with all lung specimens processed according to transplant protocols after testing.

Researchers are comparing the pain relief effects of a multiple mid-transverse process to pleura (MTP) block with patient-controlled analgesia (PCA) using morphine in adults with idiopathic scoliosis undergoing posterior spinal fusion surgery. The study addresses the challenges of managing postoperative pain and hospitalization length in this group. Regional anesthesia techniques like epidural analgesia and paravertebral blocks, enhanced by ultrasound guidance, have become important in multimodal pain management. The MTP block and erector spinae plane (ESP) block are newer methods being evaluated for postoperative pain control. Participants are randomly assigned to one of two groups. One group receives multiple MTP blocks after anesthesia induction. The other group uses intravenous PCA with morphine, starting with a loading dose before surgery ends, followed by patient-controlled doses with specified lockout intervals and background infusion rates. This randomized, double-blind trial compares these two pain management approaches during and after surgery. Throughout the study, researchers monitor pain levels 24 hours after surgery as the primary outcome. They also track intraoperative fentanyl use, timing of first rescue analgesia, total morphine use, blood pressure and heart rate every 15 minutes during surgery, patient satisfaction, and any complications within 24 hours postoperatively. The overall goal is to better understand and improve pain control strategies in scoliosis surgery patients.