Clinical Research

Areas of interest include goal-directed fluid therapy and the development of novel and monitoring devices. Some research efforts are through collaborations with the Research Development team at UC Irvine Office of Research, as well as other UC Irvine research centers and through joint projects with industry partners.

Our team of investigators has been at the forefront of hemodynamic therapy automation, developing closed-loop fluid and vasopressor therapy systems. Through single-center and multi-center studies, our investigators are advancing patient care using hemodynamic monitoring, novel techniques and systems, and deeper analysis of existing data sets. Ongoing investigations are continuing as we investigate other closed-loop hemodynamic systems. 

In addition, our team is collaborating with independent biotech companies to evaluate innovative monitors for cardiac output and blood pressure.

Selected Publications

• Sean Coeckelenbergh, Joseph Rinehart, Olivier Desebbe, Nicolas Rogoz, Amira Dagachi Mastouri, Bryan Maghen, Maxime Cannesson, Jean-Louis Vincent, Jacques Duranteau, Alexandre Joosten. Decision support guided fluid challenges and stroke volume response during high-risk surgery: a post hoc analysis of a randomized controlled trial. J Clin Monit Comput. 2025 Jun;39(3):517-522. doi: 10.1007/s10877-025-01261-7. Epub 2025 Jan 18. PMID: 39826044
   
• Sean Coeckelenbergh, Marguerite Entzeroth, Philippe Van der Linden, Moritz Flick, Maxim Soucy-Proulx, Brenton Alexander, Joseph Rinehart, Tristan Grogan, Maxime Cannesson, Jean-Louis Vincent, Eric Vicaut, Jacques Duranteau, Alexandre Joosten. Assisted Fluid Management and Sublingual Microvascular Flow During High-Risk Abdominal Surgery: A Randomized Controlled Trial. Anesth Analg. 2025 May 1;140(5):1149-1158. doi: 10.1213/ANE.0000000000007097. PMID: 39116013
   
• Sean Coeckelenbergh, Maxim Soucy-Proulx, Philippe Van der Linden, Stéphanie Roullet, Maya Moussa, Hiromi Kato, Leila Toubal, Salima Naili, Joseph Rinehart, Tristan Grogan, Maxime Cannesson, Jacques Duranteau, Alexandre Joosten. Restrictive versus Decision Support Guided Fluid Therapy during Major Hepatic Resection Surgery: A Randomized Controlled Trial. Anesthesiology. 2024 Nov 1;141(5):881-890. doi: 10.1097/ALN.0000000000005175. PMID: 39052844
   
• Sean Coeckelenbergh, Sebastian Boelefahr, Brenton Alexander, Laurent Perrin, Joseph Rinehart, Alexandre Joosten, Luc Barvais. Closed-loop anesthesia: foundations and applications in contemporary perioperative medicine. J Clin Monit Comput. 2024 Apr;38(2):487-504. doi: 10.1007/s10877-023-01111-4. Epub 2024 Jan 6. PMID: 38184504
   
• Sean Coeckelenbergh, Jean-Louis Vincent, Jacques Duranteau, Alexandre Joosten, Joseph Rinehart. Perioperative Fluid and Vasopressor Therapy in 2050: From Experimental Medicine to Personalization Through Automation. Anesth Analg. 2024 Feb 1;138(2):284-294. doi: 10.1213/ ANE.0000000000006672. Epub 2024 Jan 12. PMID: 38215708

In collaboration with the UC Irvine Susan Samueli Integrative Health Institute and UC Irvine Institute for the Study of Cannabis, our investigators are studying the use of cannabis therapy for chronic pain relief. Since the legalization of the medical usage of cannabis, the optimal concentration, dosage and method of administering cannabis for pain relief are not well-defined. Our investigators aim to establish the best recommendations for chronic pain patients, especially those who are dependent on opioids.

Select Publication

• Yeung BG, Ma MW, Scolaro JA, Nelson AM. Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Surgery. Cannabis Cannabinoid Res. 2022 Jun;7(3):328-335. doi: 10.1089/can.2021.0009. Epub 2021 Jul 5. PMID: 34227872; PMCID: PMC9225405.

We are actively engaged in advancing environmental sustainability and leading the way for sustainable healthcare across the institution. By leading research efforts to identify and create strategies to reduce waste and promote sustainability, we strive to create a sustainable healthcare system that integrates patient care with environmental responsibility and cost-efficiency. 

Greening the OR Initiative

Our team of anesthesiologists led this initiative at UCI Health to reduce the use of anesthetic gases to build toward carbon neutrality in operating rooms. Through this initiative, we were able to reduce greenhouse gas emissions associated with purchased anesthetic gases by more than 60% and completely eliminated the use of desflurane, an inhaled anesthetic gas with the highest global warming potential.

Fluid Conservation and Environmental Impact

Due to a nationwide intravenous fluids shortage, our team evaluated the impact of an intravenous fluids conservation strategy on plastic waste reduction across our four main surgical facilities. Preliminary findings from the study indicated that our strategy significantly decreased plastic waste and contributed to a reduced carbon footprint, all while maintaining the high standards of patient safety. 

Selected Presentations

• Chiou K, Field R, Dayal R, Oltean T, Coeckelenbergh S. (2025, October 12). Fluid Usage and Plastic Waste Optimization: A Quality Improvement Initiative. e-Poster Presentation. Anesthesiology 2025 Annual Meeting, San Antonio, TX, United States.
   
• Bhullar A, Rinehart J, Coeckelenbergh S. (2025, October 12). Reducing Propofol Waste During Endoscopy. e-Poster Presentation. Anesthesiology 2025 Annual Meeting, San Antonio, TX, United States.

We focus on implementing randomized controlled trials and meta-analyses to demonstrate, with a high level of evidence, the impact of different perioperative strategies. As such, we are focused on assessing and implementing pharmacologic trials and testing different tools and goal-directed strategies. Furthermore, we are dedicated to reviewing the current literature on emerging and important topics in anesthesia, critical care and pain medicine. 

Selected Publication and Presentation

• Sean Coeckelenbergh, Amelie Delaporte, Damien Rousseleau, et al. Investigating the effectiveness of an intraoperative decision support guided fluid therapy intervention on postoperative outcome of high-risk patients undergoing high-risk abdominal surgery: protocol for an international multicentre stepped-wedge cluster-randomised implementation trial. BJA Open. 2025 Jun 5:14:100421. doi: 10.1016/j.bjao.2025.100421. PMID: 40529718
   
• Chiou K, Mai D, Tiwari A, Dang P, Togashi K, Rinehart J, Engelman E, Coeckelenbergh S. (2025, April 5). Opioid-free anesthesia versus opioid-based anesthesia in video-assisted thoracoscopic surgery. Poster Presentation. California Society of Anesthesia Annual Conference, Anaheim, CA, USA.

We have led the development and implementation of the Perioperative Surgical Home (PSH) model of care, which provides a continuum of patient-centered care coordinated by a multidisciplinary team. The care model utilizes evidence-based approaches and standardized care clinical pathways that have demonstrated a sustained reduction in the complications of surgery and a shortened length of hospital stays for patients.

Selected Publications

• Kain ZN, Vakharia S, Garson L, Engwall S, Schwarzkopf R, Gupta R, Cannesson M. The perioperative surgical home as a future perioperative practice model. Anesth Analg. 2014 May;118(5):1126-30. doi: 10.1213/ANE.0000000000000190. PMID: 24781578.
   
• Pfeifer K, Ahn K, Kain ZN. Anesthesiologists and Hospitalists in Perioperative Care: Together We Are Stronger. Anesth Analg. 2022 Mar 1;134(3):463-465. doi: 10.1213/ANE.0000000000005891. PMID: 35180162.
   
• Olivier Desebbe, Thomas Lanz, Zeev Kain, Maxime Cannesson. The perioperative surgical home: An innovative, patient-centred and cost-effective perioperative care model. Anaesth Crit Care Pain Med. 2016 Feb;35(1):59-66. doi: 10.1016/j.accpm.2015.08.001. Epub 2015 Nov 21. PMID: 26613678

There have been approved studies for treating chronic headaches and migraines in adults, but there is limited scientific literature on the outcomes in pediatric patients. This study aimed to examine the outcomes of pediatric patients receiving Onabotulinumtoxin A (Botox®) for the treatment of chronic migraines to determine if there is significant improvement in the primary features (frequency, intensity, duration and disability scoring) associated with migraines compared with placebo at follow-up visits.

This study was awarded the American Society of Regional Anesthesia and Pain Medicine (ASRA) Chronic Pain Research Grant to the principal investigator, Shalini Shah, MD.

Selected Publications

• Shah S, Calderon MD, Crain N, Pham J, Rinehart J. Effectiveness of onabotulinumtoxinA (BOTOX) in pediatric patients experiencing migraines: a randomized, double-blinded, placebo-controlled crossover study in the pediatric pain population. Reg Anesth Pain Med. 2021 Jan;46(1):41-48. doi: 10.1136/rapm-2020-101605. Epub 2020 Oct 26. PMID: 33106278.
   
• Shah S, Calderon MD, Wu W, Grant J, Rinehart J. Onabotulinumtoxin A (BOTOX®) for ProphylaCTIC Treatment of Pediatric Migraine: A Retrospective Longitudinal Analysis. J Child Neurol. 2018 Aug;33(9):580-586. doi: 10.1177/0883073818776142. Epub 2018 Jun 7. PMID: 29877131.