Using Big Data Approaches to Enhance Fluid Stewardship in Intensive Care Unit

Charles University, Third Faculty of Medicine, Dept. of Anaesthesia and Intensive Care Medicine 

An enthusiastic group of young scientists mostly from Charles University in Prague and UMC Amsterdam is looking for a junior colleague who is willing to join our team and take over Dysnatraemia subproject.

Background: Fluid management is a central focus of all critical care admissions. Optimization of volume status requires balancing resuscitative and deresuscitative efforts, maintenance and replacement fluids, and fluid creep. Inadvertently, many patients develop acid-base and electrolyte derangements such as dysnatremia and surges of unmeasured ions. Most ICUs have direct access to information relating to electrolyte and fluid derangements. However, individual derangements offer little insight as they are often biologically insensitive, mechanistically uninformative, and statistically insignificant in heterogeneous and complex ICU contexts. Larger trials only give limited insight into these issues; e.g. the clinical effect of two, crudely different, crystalloid compositions has only recently been demonstrated. Current advances in data science and data exchange allow us to contextualize electrolyte derangements across extremely large sample sizes. In this research line we aim to use big data to answer physiological questions pertaining to acid-base and electrolyte derangements on the ICU and vice versa.

Research questions

What is the epidemiology of dysnatraemias on admissions to ICU?

• What is the incidence of severe dysnatremias?
• How this evolves over time?

What is the epidemiology of dysnatraemias that occurred during ICU stay?

• What is the incidence of severe dysnatremias?
• How this evolves over time?
• How long did they last?
• What factors are associated with dysnatremias in terms of i.v. fluids, diuretics, fluid balance, disease severity, and hyperglycaemia or insulin infusion ?

Are dysnatraemia associated with ICU LOS and ICU mortality after adjustment to other factors?

• What is the association between dysnatremias and the use of antipsychotics in ICU?

Hypothesis: Deresuscitation efforts in stabilisation phase of critical illness combined with catabolic urea load leads to ICU-acquired hypernatremia, which associates with delirium and mortality.

Methodology: The primary research method is big data approach. We have access to Prague MV database and AmsterdamUMCdb containing de-identified deidentified record-level data from nearly 100 000 critically ill patients. Should physiological hypotheses arise from data analyses, these can be tested as Prague center has infrastructure for clinical research (incl. 5 research nurses) and Carboxylab equipped with analytical tools and acid-base tonometry.

The Team

Mostly consists from research oriented intensivist grouped around Prague Summer School of Acid Base and Homeostasis and Data-Analysts from AmsterdamUMCdb, the first free European ICU database.

• Micah Heldeweg; Amsterdam University Medical Center, Department of Adult Intensive Care; Postdoc Charles University; project lead
• František Duška; Charles University; professor of anesthesia and critical care
• Petr Waldauf; Charles University Data-analyst
• Julius Stohlmann; Amsterdam University; PhD student & fellow ICU

Dual PhD programme (cotutelle) between Charles University and University of Amsterdam will be encouraged.

Entry Requirements

1. A Master's degree (or equivalent) in a relevant field such as Medicine, Biomedical Sciences, Data Science, Bioinformatics, or a related discipline.
2. Strong academic background and research experience, preferably with experience in the fields related to the research topics.
3. Willingness to learn advanced statistical analysis and data interpretation.
4. Excellent written and verbal communication skills in English.
5. Ability to work independently as well as collaboratively within an interdisciplinary team, ability and willingness to travel.
6. European students are eligible for this funded project.

How to Apply

Application website: https://www.lf3.cuni.cz/3LFEN-693.html

Interested candidates should submit the following documents via email to Professor František Duška ([Email Address Removed]):

1. Curriculum Vitae (CV) including contact information, educational background, research experience, publications (if any), and relevant skills.
2. Cover letter outlining your motivation for applying to this project, research interests, relevant experience, and how your skills align with the project goals (max 1 page).
3. Contact information for at least two academic referees who can provide letters of recommendation upon request.