Active Studies

In 10-20% of emergency tracheal intubations, clinicians are unable to intubate the trachea on the first attempt, which increases the risk of complications during intubation. Two types of laryngoscope blades are available for use with video laryngoscopes in clinical care: Standard geometry blades or hyperangulated blades. The primary aim is to compare the effect of use of a hyperangulated video laryngoscope blade versus use of a standard geometry video laryngoscope blade on the incidence of successful intubation on the first attempt among critically ill adults undergoing tracheal intubation. The secondary aim is to compare the effect of use of a hyperangulated video laryngoscope blade versus standard geometry blade on the incidence of hypoxemia (defined as peripheral oxygen saturation <85% during the interval between induction and 2 minutes after tracheal intubation) during intubation of critically ill adults.

Novel synthetic fentanyl analogues (fentalogs) pose a major public health threat and have enhanced potency and addictive potential. This study aims to molecularly identify and quantify fentalogs in patients with opioid overdose (OD), evaluate the medical consequences of fentalog OD, and track outbreaks across the ToxIC Network, ultimately addressing knowledge gaps and informing strategies for diagnosis and management. 

Acute Respiratory Distress Syndrome (ARDS) affects nearly a quarter of mechanically ventilated ICU patients and carries a high risk of death. Mechanical ventilation is necessary for treatment but can also cause further lung damage, known as Ventilator-Induced Lung Injury (VILI), particularly in patients with severely reduced lung volume ("baby lung"). Standard ventilation strategies do not account for individual differences in lung mechanics, which can lead to harmful levels of lung stress. The PREVENT-VILI trial is a multicenter, phase III study testing a precision ventilation approach that adjusts PEEP and tidal volume based on each patient’s physiology—specifically targeting a lung end-expiratory pressure near zero and a driving pressure of 12 cm H₂O or less. The goal is to reduce lung injury, improve survival, and enhance recovery in patients with moderate-to-severe ARDS. 

PRACTICAL is a global, multi-center adaptive platform trial designed to evaluate strategies for invasive mechanical ventilation (IMV) in patients with acute hypoxemic respiratory failure (AHRF), including Acute Respiratory Distress Syndrome (ARDS). Each year, tens of thousands of critically ill patients worldwide require IMV, with mortality rates ranging from 20–50%. While mechanical ventilation is lifesaving, it can simultaneously cause harm, including ventilator-induced lung injury (VILI), ventilator-induced diaphragm dysfunction (VIDD), and patient self-inflicted lung injury (P-SILI). These complications contribute to prolonged ventilation, increased risk of infection, ICU-acquired weakness, and long-term disability. The primary objective for the domain is to identify the IMV strategy that most effectively improves patient outcomes among a range of strategies including conventional lung-protective ventilation. Secondary objectives include assessing feasibility and safety, and characterizing physiological and biological effects of novel ventilation approaches. 

PREPARE is a surveillance and clinical research study focused on identifying and characterizing respiratory infections among older adults presenting to the Emergency Department. Through frontline emergency department surveillance and pathogen monitoring, PREPARE contributes to ongoing research on emerging respiratory illnesses and helps strengthen public health preparedness and response efforts in the post-COVID-19 era. 

(IRB#15-001602)

Background

Unrecognized abdominal and pelvic injuries can result in catastrophic disability and death. Sporadic reports of “occult” injuries have generated concern, and physicians, fearing that they may miss such an injury, have adopted the practice of obtaining computed tomography on virtually all patients with significant blunt trauma. This practice exposes large numbers patients to dangerous radiation at considerable expense, while detecting injuries in a small minority of cases. Existing data suggest that a limited number of criteria can reliably identify blunt injury victims who have “no risk” of abdominal or pelvic injuries, and hence no need for computed tomography (CT), without misidentifying any injured patient. It is estimated that nationwide implementation of such criteria could result in an annual reduction in radiographic charges of $75 million, and a significant decrease in radiation exposure and radiation induced malignancies.

Objective

This study seeks to determine whether “low risk” criteria can reliably identify patients who have sustained significant abdominal or pelvic injuries and safely decrease CT imaging of blunt trauma patients.

Our Role

All blunt trauma victims undergoing computed tomography (CT) of the abdomen/pelvis in the emergency department (ED) will undergo routine clinical evaluations prior to radiographic imaging. Our volunteers will observe and record vitals for each trauma patient. We are also responsible for assuring that ED physicians record the presence or absence of specific clinical findings as well as the presence or absence of abdominal or pelvic injuries.

From August 2022 to September 2023, there were 1,872 reported new HIV diagnoses in LA County, representing a 13% increase from the prior year. PrEP (pre-exposure prophylaxis) is a highly effective biomedical intervention for individuals at risk of HIV, including people with substance use disorders. However, little is known about patient perspectives on initiating PrEP in emergency departments (EDs), even though EDs are a frequent point of care for many populations at increased risk of HIV. The primary aim of this study is to evaluate perspectives, barriers, and facilitators to initiating and taking pre-exposure prophylaxis (PrEP) among emergency department (ED) patients with substance use disorders.