Within our research infrastructure, multiple smaller research projects are tested and provide young researchers with opportunities to discover critical care research within a structured environment.
Tissue oxygen saturation (StO2) was measured using NIRS at both thenar and knee area. Microcirculatory status was defined as ‘poor’ or ‘good’ depending on the researcher’s clinical estimation. Microcirculatory variables potentially predictive of StO2 were analyzed.
PEEP AND CARDIAC OUTPUT
In mechanically ventilated patients hemodynamic variables were recorded using CCUS before and after elevation of positive end-expiratory pressure (PEEP). We aimed to evaluate the influence of elevating PEEP on cardiac output and other hemodynamic variables.
LUNG ULTRASOUND AND AUSCULTATION
We aimed to compare lung ultrasound and auscultation for the assessment of fluid overload in critically ill patients.
RIGHT VENTRICULAR FUNCTION AND MORTALITY
We measured Tricuspid Annular Plane Systolic Excursion (TAPSE) and RV Systolic Excursion Velocity (RV S`) and associated it with 90-day mortality.
CENTRAL AND PERIPHERAL CIRCULATION
Doppler flow measurements of right and left common carotid arteries (CCA), right and left subclavian arteries (SCA) and right and left common femoral arteries (CFA) were performed. CO was measured by CCUS. By this we aimed to to investigate whether the amount of blood flow of the vital abdominal organs could be assessed from central and peripheral blood flow, using the cardiac output and peripheral flow measurements, and whether calculated vital organ blood flow might be associated with organ failure of abdominal organs.
MINIMALLY INVASIVE CARDIAC OUTPUT MONITORING
We evaluated the precision, accuracy and agreement of uncalibrated arterial waveform derived CO measurements (FloTrac) compared to CCUS as a reference technique in critically ill patients with circulatory shock. CO was measured multiple times in each patient during ICU admission using the FloTrac device (fourth-generation software) and results were compared to concurrent echocardiographic CO measurements.
REPEATED MEASURES AND MORTALITY
Within 24 hours of admittance, the first measurement (T1) including physical examination and CCUS was performed. Approximately 24 hours hereafter the measurements were repeated (T2). We associated the measures with 90-day mortality.
RIGHT VENTRICULAR FUNCTION AND AKI
We evaluated the association between right ventricle overload as a proxy for venous congestion and AKI. Secondly, we assessed the association between right ventricle overload on 7 day mortality in patients with and without AKI.
PASSIVE LEG RAISING
We aimed to evaluate the effects of two different methods of passive leg raising on cardiac output in a general intensive care population. If mechanically ventilated, we also aimed to evaluate the change in cardiac output by an increase in positive end-expiratory pressure to 15cmH2O (PEEP-test) in responders versus non-responders.
DEFINITION OF ARDS
This study evaluated the diagnostic accuracy of B+ lines on pulmonary ultrasound in diagnosing acute respiratory distress syndrome (ARDS) in acutely admitted patients during the first 24 hours of ICU stay. Also, the diagnostic accuracy of B+ lines in the Berlin definition as a substitute of the chest imaging criterion and the difference in cardiac function between patients with and without ARDS were assessed.
END-TIDAL CO2 AND CARDIAC OUTPUT
For prediction of fluid responsiveness is in this study the CO measured with CCUS during the passive leg raising (PLR), all predefined in protocol. The primary research question was; “Is end-tidal CO2 (ET-CO2) a good predictor of fluid responsiveness in critically ill patients, in comparison with gold standard measurements of CO using echocardiography?”.
ADVANCED RIGHT VENTRICLE ULTRASONOGRAPHY
After performance of physical examination and CCUS with tissue-Doppler imaging, strain analysis was applied in three segments of the RV free wall and septum. Global longitudinal RV peak strain (GLPS) and RV free wall longitudinal peak strain (RVLPS) were calculated afterwards.
TRAINING MEDICAL STUDENTS
Study I: Third year medical students performed hemodynamic estimates on various patient cases at three different intervals: before (T0), after practical sessions (T1), and after an E-learning module (T2). Assessments comprised a categorical estimate of cardiac index (CI) as obtained by critical care ultrasonography (CCUS), and an estimate of the type of shock. The clinical variables of patient cases were obtained within 24 hours of patients acutely admitted to the ICU.
Study II: Furthermore, in a different study population the effect of advanced medical training on hemodynamic estimates was examined.
ADVANCED LEFT VENTRICLE ULTRASONOGRAPHY
The objective of this study was to determine the feasibility of advanced techniques of CCUS in critically ill patients and the correlation between these techniques. Global Longitudinal Strain (GLS) was a measured by Tissue Doppler Imaging (TDI) and Speckle Tracking Imaging (STE).
MACHINE LEARNING IN ORTHOTROPIC LIVER TRANSPLANTATION
We employed a Machine Learning (ML)-based framework to probabilistically track the evolution of SICS patients. To define the most important variables for a prospective study of post-OLT patients, we identified the most predictive variables from the ML analysis. For the ML-based predictive analysis, cardiac ultrasound, physical examination, and laboratory data from non-OLT patients were used to train three predictive models. These models were then used to predict the individual patient probability for in-ICU mortality for each patient who underwent OLT.
The cumulative fluid balance within 3, 24 and 48 hours after admission was associated with acute kidney injury.
VENOUS THROMBOEMBOLISM IN ICU
What is the incidence of venous thromboembolism (VTE) and risk factors for VTE in our SICS cohort? In our cohort we collect all known variables for venous thromboembolism and hope to identify additional risk factors.
IVC COLLAPSIBILITY AND AKI
Is the IVC collapsibility associated with perfusion variables of the kidney? In a subgroup of patients we will analyse the observations of whole-body ultrasonography with a special focus on venous congestion and renal perfusion.
PROBE USE IN PULMONARY ULTRASOUND
There is no consensus about which probes to use when performing pulmonary ultrasound. Within this substudy we aim to compare multiple probes when assessing Kerly B-Lines in our patients.
Can we validate all existing risk scores in a contemporary cohort op acutely admitted ICU patients? We performed a systematic review of all risk scores and will validate them in SICS-I and SICS-II.
UNEXPECTED FINDINGS IN WHOLE BODY ULTRASONOGRAPHY
As there are few studies that have performed whole body ultrasonography in a large group of unselected critically ill patients, we will record the number of unexpected findings seen on ultrasonography, such as renal cysts.