Research group of Anesthesiology

Over the following years, we are facing an increasing need for medical care due to a higher proportion of elderly people. At the same time, new and more efficient but also more expensive and more resource-demanding treatment options are developed. On the other hand, surgical procedures become less invasive, and procedures are expanding from the surgical unit to different hybrid environments, which sets new requirements for anesthesia care. Moreover, patient monitoring during the perioperative process also becomes less invasive and new technologies will be available. At the same time, the economical resources are limited as the size of the workforce decreases in developed countries. The focus of the unit’s research is the impact of patient-, technology- and society-related factors on the outcome of the perioperative process and different patient processes of acute care. The research questions are raised from the daily clinical life in the developing environment, organization and technology. The research group will closely collaborate with the clinicians and heads of the units to solve these clinical problems using a scientific approach. Also, the research group is open to new and innovative technical solutions and aims to collaborate with corporate life.

To face the research challenges, the focus of the research group of Anesthesiology include the following branches:

1. Outcome of the process of major surgery and invasive procedures

Our previous results clearly showed that patient-related factors, such as malnutrition, increase the risk of unfavorable outcomes after major surgery for the cancer of the head and neck. We also found a significant reduction in daily life–related quality of life such as difficulties in eating and speaking. We have now built up a project to examine these factors and create preventive interventions. We previously found postoperative medical complications to be the most significant risk factors for adverse outcomes, poor quality of life, and long-term mortality. We also aim to uncover factors that increase the risk of unfavorable outcomes within the perioperative process. The possible factors include pre- and postoperative nutritional status and nutritional therapy. This risk analysis will be implemented also to other patient groups, such as urgent laparotomies and invasive procedures due to ischemic strokes, hip fractures and intestinal resections due to chronic inflammatory bowel diseases. The coordinators of this branch are Sanna Lahtinen (M.D., Ph.D.), Siiri Hietanen (M.D., Ph.D.) and Janne Liisanantti (M.D., Ph.D.).

2. Intraoperative monitoring as a part of the perioperative process

Optimal fluid management and the use of vasoactive medications, so called goal-directed therapy, is of paramount importance in cardiac and major noncardiac surgery. Managing the goal directed therapy in these settings is challenging and often requires invasive procedures such as central cannulation with pulmonary artery catheter, which is prone to complications, although they are rare. We examined the use of stroke volume variation in fluid management in the free flap surgery for the cancer of the head and neck and found a significant decrease in the volume load in these patients. We have started a project to validate the use of non-invasive cardiac output monitoring in a real-life setting. We have already validated bioreactance and non-calibrated mini-invasive pulse contour techniques in major surgery including off-pump coronary bypass grafting, on-pump cardiac surgery, abdominal aortic surgery and major abdominal surgery. Mini-invasive devices are not yet accurate enough to replace pulmonary artery catheters in these settings. Moreover, we are aiming to further validate the current paradigm of performing goal-directed therapy in cardiac surgery patients at our institution. Last, we have started a project to validate the accuracy and precision of hemodynamic parameters acquired with transthoracic ultrasound performed by intensivists compared to pulmonary artery catheter in the intensive care unit setting.

Initiatives to define the actual need for invasive monitoring and study the real-life accuracy and precision of mini-invasive hemodynamic monitors could reduce costs in multiple ways. If mini-invasive monitors and ultrasound methods appear accurate enough, their use may reduce complications related to the use of invasive devices, makings investments to monitor hardware and personnel training worthwhile. On the other hand, if the use of invasive monitoring seems to be the only way to monitor patients accurately and precisely, their use is validated also in the future. Finally, optimal therapeutical targets in guiding the fluid and vasoactive therapies during major cardiac and noncardiac surgery may further lead to improved patient outcomes. The coordinators of this branch are Timo Kaakinen (M.D., Ph.D.) and Tiina Erkinaro (M.D., Ph.D.)

3. The impact of anesthesia method on the perioperative process outcomes

The ideal choice of the anesthesia method is of great importance in the perioperative process. The chosen method may influence the long-term outcome such as mortality, morbidity and the length of stay as well as short term outcomes such as postoperative pain, nausea and functional recovery. In a retrospective series we found that in below-knee amputations spinal anesthesia had several benefits compared to general anesthesia. In another retrospective series, we found out that spinal anesthesia is beneficial during ankle fracture surgery, as it is associated with less postoperative pain, less need for pain medication and less nausea and vomiting. We have started to examine these differences in postoperative pain and recovery in patients with ankle and tibial shaft fractures as well as elective foot surgery in various settings, including two prospective, randomized and controlled trials. The coordinators of this branch are Timo Kaakinen (M.D., Ph.D.) and Merja Vakkala (M.D., Ph.D.).

4. Substance use in acute care

The harmful use of alcoho­­­­l and other substances is a major concern in acute care. In our study material, every third ICU-admitted trauma patient was intoxicated by alcohol or other substances on admission; furthermore, every third non-traumatic ICU patient had alcohol-related health problems. We have conducted also a study with Northern Finland Birth Cohort 1966 examining the role of alcohol consumption in the later need of intensive care with prospectively collected data on substance use. The same project includes socioeconomic data, and we plan to compare the socioeconomic well-being of the ICU-admitted patients with the rest of the cohort population. We have also an on-going study of epidemiology of poisonings in the area.

Chronic heavy alcohol consumption has been associated with alterations in several organ functions leading to difficulties in the maintenance of homeostasis especially in acute setting. Our future interest is to examine the prevalence of heavy alcohol consumption in patients requiring emergency surgery. Our aim is to investigate whether heavy alcohol consumption has an effect on the complications during the intraoperative anesthesia and immediate postoperative care. The coordinator of this branch is Janne Liisanantti (M.D., Ph.D.) and the projects collaborates with the research group of intensive care medicine.

5. Pre-hospital emergency care and the treatment pathways of urgent patient

The pre-hospital care has developed over the years. New techniques and diagnostic tools, such as bedside laboratory tests, are now part of the daily practice. Also, advanced level pre-hospital care is delivered by more educated personnel and the patients are transported multimodally, by EMS or HEMS. Using a large pre-hospital care database (nearly 70,000 missions per year), which includes vital parameters and data on commenced care, we aim to analyze the impact of pre-hospital care on the outcomes and treatment pathways. We have found large regional differences in the use of EMS-services and we continue to examine this phenomenon. Moreover, urgent care in the Northern Ostrobothnia Hospital District is centralized in Oulu University hospital, which makes a challenge to the EMS. The coordinators of this branch are Lasse Raatiniemi (M.D., Ph.D.) and Janne Liisanantti (M.D., Ph.D.) , and Sanna Lahtinen (M.D., Ph.D.)

6. AICCELERATE-project

AICCELERATE is a European project that aims to boost Artificial Intelligence (AI) solutions to allow hospitals to improve their efficiency and the quality of patient care through three concrete pilots that will be carried out in five European hospitals.

Nowadays, most AI solutions applied to the health sector are limited to isolated applications. For this reason, scalable models that address data sharing, integration, privacy, and ethics are needed to ensure better adoption of AI in healthcare fields.

The project introduces an approach for scaling up AI-based digital solutions through the Smart Hospital Care Pathway Engine (SHCP Engine), and the goal is to demonstrate its scalability with different types of healthcare use cases.

The SHCP Engine will serve as a toolset of AI-based solutions models, including robotics & IoT to improve quality of care and health outcomes. The tools will be tested in the three pilots that will provide feedback for improving the engine. These pilots are:

• PILOT 1. Patient flow management for surgical units
• PILOT 2. Digital care pathway for chronic adult care focused on Parkinson’s disease
• PILOT 3. Palliative and chronic paediatric service delivery and patient workflow

The AI solutions generated by the engine will provide predictions based on machine learning and through robotics use and multiple data input sources. The SHCP Engine will approach the hospital challenges from two perspectives: the patients' and the hospital management. From a patient perspective, the solutions will enhance digital care pathways designed for chronic diseases to empower the patients and allocate the resources of health care professionals more efficiently. From the hospital perspective, the engine will help to optimise the patient flow management system. Patient empowerment and evidence-based trust towards Artificial Intelligence will be a key part of the project.

Project duration is three years and four months during 2021-2024. Oulu University Hospital leads the functional specification and pilot execution in the project. Key medical expertise contributor from Oulu University Hospital is Janne Liisanantti (M.D., Ph.D.) Project Manager is Timo Alalääkkölä (M.Sc.).

Funding :

• Finnish Association for Alcohol Research
• Thelma Mäkikyrö Foundation
• Finnish Medical Association Duodecim