Helena Odenstedt Hergès: Fighting to expand research on the sickest patients
She is head of the research area of anesthesiology and intensive care—where patients are often unconscious, critically ill, and unable to be asked about participating in research projects. For Helena Odenstedt Hergès, a key part of the research effort is getting approval to study this patient group at all.
Anesthesiology and intensive care is an area unlike many others in clinical research.
“We exist a bit on the side. All our patients belong to other specialties, and we have neither our own diagnoses nor patient organizations. We are rarely the primary specialty that can apply for grants tied to specific conditions. But we are the ones who care for the sickest patients,” says Helena Odenstedt Hergès, associate professor and head of research area in anesthesiology and intensive care at The Institute of Clinical Sciences.
Ethical challenges and legal barriers
Doing research on critically ill patients brings challenges, both medical and ethical as well as legal. Many who could be included in studies are unconscious or too affected to give consent.
“We then have to rely on consultation with family members. But relatives cannot make decisions on behalf of the patient. They can only help until the patient can be asked directly. And in certain acute conditions, such as stroke, there is no time to find family members. That would delay life-saving treatment.”
In emergency situations, it can even be difficult to find a way to conduct purely observational studies that are completely harmless to the patient, due to current legislation. This is despite the fact that such research could ultimately be crucial for developing methods to monitor patients with life-threatening conditions.
Research shapes the clinician
Helena Odenstedt Hergès defended her doctoral thesis in 2005 on monitoring breathing and circulation in critically ill patients. She has carried that knowledge into daily clinical practice in many patient encounters.
“It was very educational. I became a better clinician through research. It is about understanding physiology and what happens when the body fails.”
She is now involved in a larger project focused on how unconscious patients’ neurology can be monitored more effectively. The aim is to detect early signs of stroke so that interventions can be made to prevent permanent brain damage.
We hope to build an early warning system that can alert us to an emerging stroke
“Often we do not realize that a stroke has occurred because the patient is sedated and cannot participate in a neurological exam. We use various monitoring techniques to detect changes in patterns of heart rhythm, EEG – the brain’s electrical activity – and brain oxygenation. As part of the project, a machine learning algorithm has been developed and trained to identify the onset of cerebral hypoperfusion with incipient cerebral ischemia. We hope that the system will be able to detect these signals in real time. We collaborate with several clinical specialties and expertise within software engineering at the University of Gothenburg.”
She teaches medical students and supervises researchers, while also working clinically in intensive care.
“It adds credibility to teaching and is absolutely essential for research. You have to stay close to clinical practice to know what is important to study and develop.”
Decisions without scientific support
Intensive care is a resource-intensive field where decisions often must be made quickly, sometimes without scientific evidence.
“There are guidelines, but not for everything. For those who are critically ill or dying, there are limited studies showing how we should treat that patient. Then it is about weighing each situation as it happens. The more knowledge and understanding one has of physiology, the more well-founded decisions can be made. We also always work as a team – physicians from different specialties, nurses, and assistant nurses.”
We see all specialties and are like the hospital’s general practitioners
Helena Odenstedt Hergès has conducted research on both ventilator treatment and cerebral hypoxia, as well as on the follow-up of patients after intensive care.
“We must also be able to show that what we do truly benefits patients. Not only to save lives, but to save lives worth living, with quality of life. Are patients satisfied with the care they received, three months or a year later? We need to find out. Or do they wish they had not undergone treatment? That knowledge can be important for deciding which resources are worth investing in for different interventions.”
Text and photos: Jakob Lundberg