Ala-Kokko Tero

Intensive Care Medicine Research Group

 

Research unit: Surgery, Anesthesia and Intensive Care

 

Group leader

Professor Tero Ala-Kokko (MD, PhD, EDICM), the Chief of Intensive Care Medicine at Oulu University Hospital

 

What do we do

The incidence of sepsis requiring intensive care is increasing with high one year mortality of 41 % in Finland as well as in other countries, despite the advances in antimicrobial and organ supportive therapies. According to our findings adequate fibrinogenic response seems to be crucial to successful healing of sepsis related organ damage as the markers of extracellular matrix remodelling correlate with disease severity and mortality. Methods for early detection of sepsis are crucial for survival. According to our findings characterization of leucocyte surface molecules may provide new diagnostic tools for early detection of sepsis. Our studies may have a major impact on the diagnostics and treatment of severe sepsis which is an increasing health problem worldwide with high costs, mortality and long term morbidity. Studies on pathophysiology will bring new ideas for the diagnostics and treatment of this population. Modulation of inflammation and organ healing is hypothesized to be in the center of future treatments. Our experimental ex vivo wound model will be further used to study the effect of critical illness on wound healing and tissue repair. Machine learning technology is currently developed in our unit to improve early diagnostics of critical illness syndromes.

In post out of hospital cardiac arrest patients a new prognostic tool for neurological prognostication is under development. We have shown that the diagnostic value of EEG signal analysis based on responses to so called propofol-stress well categorizes patients according to their neurological outcome. In the future if proved valid it will be tested also in patients with other types of encephalopathy such as septic encephalopathy as a prognostic tool of neurological recovery. New EEG signal analysis methods will be further developed and validated for better detection of brain dysfunction related to critical illness and patient outcome prediction as well as assessing treatment modalities for prevention of cognitive adverse outcomes.

Health related quality of life is an important patient centered outcome. Long term outcome of physical and psychological factors, functional outcome and socioeconomic wellbeing after critical illness ultimately determine the success of intensive care and its cost effectiveness. National registries together with our electronic clinical information system, hospital information system and cohort 66 registries all provide a unique data base environment for studies looking at intensive care resource use and patient centered outcomes. The results can be used for planning healthcare provision and when deciding healthcare resource allocation at national and international level. National registries including Northern Finland birth cohorts will be used to gain population level data on the epidemiology of critical illness and its significance on healthcare use and outcome. Emergency medicine processes will be evaluated, and more effective acute care pathways are under development by our team using regional networks.

Our current research activity

  • Pathophysiology of sepsis and organ dysfunctions:
    • Wound healing in severe sepsis
    • Septic encephalopathy
    • EEG signal analysis in outcome prediction and detection of brain dysfunction
    • Sense based neuromodulation and kinesthetics
  • Epidemiology, diagnostics and outcome of severe infections:
    • Severe pneumonia in the ICU
    • Prevention of VAP
    • Early sepsis detection using machine learning
    • Biomarkers in sepsis diagnostics
  • Hemostasis in the critically ill:
    • Hypercoagulation detected with TEG and thromboembolic complication in high risk surgical patients
    • Hemostasis in stroke and cerebral bleeding
  • Health care processes:
    • Outcome, quality of life, physical, mental and socioeconomic wellbeing of children and adults after ICU treatment
    • Post ICU follow up clinic
    • Regional differences in the use of emergency ambulance services
    • Pharyngeal Electrical Stimulation Therapy for ICU dysphagia
    • Cancer patients in the ICU
    • Alcohol and acute illness
    • Emergency medicine care pathway

 

Our team

  • Koskenkari Juha, Docent
  • Laurila Jouko, Docent
  • Syrjälä Hannu, Docent

Post doc researchers

  • Jansson Miia
  • Karhu Jaana
  • Kortelainen Jukka

PhD students

  • Erikson Kristo
  • Jaurila Henna
  • Kyösti Elina
  • Niittyvuopio Miikka
  • Pohjola Mari
  • Roivainen Petri

The division of intensive care will provide a study nurse, clinical patient material and care of the study patients as well partly funding from the hospital EVO grants and the services of a medical biostatistician.

 

Where are we headed

Sepsis research will be even more translational and still focus on understanding the pathophysiology to find new diagnostic tools and treatment options. Registry and cohort studies as well as quality of life studies will focus on healthcare process improvement.

Our study objectives

  • to gain more knowledge on the pathophysiology of sepsis especially on wound healing in sepsis and septic encephalopathy
  • to evaluate and develop new technologies to improve early diagnostics, prognostication and monitoring of critical illness
  • to explore healthcare processes, acute care pathways, cost effectiveness and performance improvements regarding critical illness with patient centered outcomes

 

Our main collaborators

FINNICU national study consortium
The research team is a multidisciplinary team covering critical care, infectious disease, emergency medicine, surgery, pathology, nursing, radiology, pediatrics and clinical chemistry.
 

How to find us

Division of Intensive Care Medicine, Oulu University Hospital, Oulu, Finland,
PO BOX 22, 90029 OUH 
tel: +(358)83153675
tero.alakokko[at]oulu.fi

Last updated: 17.1.2020