perioperative point-of-care ultrasound

Conditions: Anesthesia; Ultrasound; Emergencies; Operation; Ultrasonography; Surgery

Summary: the goal of this study is to assess the impact of perioperative point-of-care ultrasound (pocus) assessment on patient-important outcomes (e.g. hospital length of stay, length of stay in recovery, mortality etc.) and perioperative patient management strategies, in patients undergoing non-elective non-cardiac surgeries.

preoperative patients undergoing emergency non-cardiac surgery will be approached for study recruitment and participation. study participants will be randomized to receive, or not, a preoperative pocus exam as part of their routine preoperative assessment. patients randomized to receiving a pocus exam will undergo a protocolized focused cardiac ultrasound, lung and pleural ultrasound and a gastric volume and content ultrasound assessment. results of this exam will be disclosed to the anesthesiologist and primary care team. randomization will be stratified by the presence of any sign(s) of cardiorespiratory failure. signs of cardiorespiratory failure are defined as: systolic blood pressure \ 100, respiratory rate \>24, oxygen saturation \ 20). outcome data will be collected prospectively. investigators performing and interpreting the scan will disclose the results to the care team but will not participate in patient care. primary and secondary outcome data collection will be performed by an investigator blinded to patient assignment. the primary outcome is post anesthetic care unit length-of-stay. the secondary outcomes are post-randomization hospital length of stay, number of operating room (or) delays for optimization, alterations in anesthetic management (using a brief anesthesiologist-administered survey), intensiveness of or management (invasive blood pressure monitoring, central venous pressure monitoring, intraoperative tee), new peri-operative diuretic use, new intensive care admission rates, mortality during this admission, amount/frequency of postoperative investigations, rates of detection of new pathologies identified by preoperative pocus exam and the rates of adequately diagnostic pocus studies.

Eligibility criteria:
inclusion criteria: * patients aged \>17 years * undergoing urgent or emergent non-cardiac surgery classified as intermediate or high risk according to american heart association(aha)/american college of cardiology(acc) guidelines. these include vascular surgeries (supra or infra-inguinal), intraperitoneal surgeries, intra-thoracic surgeries, head and neck surgeries, spine surgeries, urologic surgeries, and proximal extremity orthopedic surgeries. peripheral extremity surgeries (wrist or below, and ankle or below), in addition to appendectomies and cholecystectomy surgeries will be excluded from this study. exclusion criteria: * patients scheduled for elective or pre-booked surgeries * patients undergoing cardiac surgeries * patients undergoing low risk procedures e.g. endoscopic procedures, superficial skin, subcutaneous tissue, breast, ophthalmic, and ambulatory surgeries * patients undergoing orthopedic peripheral extremity surgeries (e.g. ankle, wrist, hand, foot) * patients who have had an echo during the current hospital admission prior to recruitment. * patients where the investigator performing or over-reading the pocus scan is required to participate directly in perioperative patient care (e.g. anesthesiologist co-investigator performing or over-reading scan is on-call for this emergency case)

Keywords: preoperative, perioperative, point-of-care ultrasound