Main Areas of Work
- Fluid overload and infusion therapy in critically ill patients
- Electrolyte and acid/base disorders in critically ill patients
- Evaluation of metabolic changes and biomarkers in the diagnosis and prognostic evaluation of critical diseases
- Evaluation and development of prognostic scores for diagnosis and prognostic evaluation in acute medicine
- Evaluation of trigger factors, diagnostic methods and therapeutic approaches in critically ill patients with renal failure
Brief description
One of our main areas of interest is preventing fluid overload in critically ill patients. Fluid overload leads to increasedmortality in critically ill patients. One difficult aspect is that critically ill patients must be given fluid, as this is needed tosupport their circulation. Our objective is to develop methods that reduce fluid overload.
We are also studying the best approach to select infusion for the individual patient. In current intensive care medicine,infusion therapy is quite unselective. One problem is that currently available infusion fluids have a variety of differentcompositions of buffers and electrolytes and these have different effects on organ function (e.g. heart, brain, kidneys). Theobjective of our group is to identify which group of patients benefits most from which infusion fluid.
Aside from infusion therapy, we are also studying electrolyte and acid-base disorders in critically ill patients. Thesedisorders are closely – but not exclusively – associated with infusion therapy and their clinical relevance is uncertain. Thisis particularly the case for chloride disorders.
Another area of our research is the assessment of clinical chemical markers and their use in severely ill patients. Inparticular, we have performed various studies on D-dimers and thromboembolism (thromboses, pulmonary embolisms).Thromboembolisms are associated with high mortality and must be reliably excluded if suspected. In the clinic, this can beachieved by combining measurements of D-dimers with imaging procedures (if necessary). Problematically, many patientshave individual factors that can influence D-dimer concentrations and thus clinical testing gives a false positive results andpatients undergo unnecessary radiation exposure. In spite of this, the objective of our group is to develop patient-adaptedcut-offs for D-dimers.
Our research work has led to a broad spectrum of projects ranging from meta-analysis and systematic reviews to big-dataprojects on randomised double blind prospective studies.
Associated staff
PD Dr. med.
Anna
Messmer
Head of Research Group «Capillary leak andbiomarker»
Martin
Faltys, MD
Subgroupleader AI & big data
Benjamin
Hess, MD
Debora
Hofer, MD
Michel
Moser, PhD
Jan
Waskowski, MD
.
Björn
Zante, MD
.
Current projects
- «REDUCE», protocolized early de-resuscitation in patients with septic shock, single center IIT (investigator-initiated trial) initiated by the Pfortmueller group
- «HERACLES», Hypertonic saline in patients after cardiac surgery, single center IIT initiated by the Pfortmueller group
- «CRYSTALLBrain», Crystalloid fluid choice and neurological outcome in patients after subarachnoid haemorrhage, multicenter IIT initiated by the Pfortmueller group
- «CLASSIC», international randomized controlled clinical trial comparing restrictive versus liberal fluid therapy in patients with septic shock, international IIT from Danemark (Prof. A. Perner)
- «TARTARE-2S», international randomized controlled trial comparing a macro-circulation to a tissue perfusion targeted management in patients with septic shock, international IIT from Finland (Prof. V. Pettilä)
- «Hypo-P-ICU», international prevalence study on hypophosphataemia on the ICU, international IIT powered by the ESICM from Switzerland (Prof. M. Berger, Lausanne)
- «Fluid overload in the critically ill: root-cause analysis and patient-centered outcomes», big data project on contributing factors and patient-relevant outcomes in the critical illness
- «Chloride disorders in the critically ill: causes, consequences and relevance», big data project evaluating the relevance of chloride disorders in critical illness
- «Patient-adjusted D-dimer cut-off levels for diagnosis of venous thromboembolic disease– A systematic review and meta-analysis»
- «INDIVIDUALIZE», Individualized D-dimer cut-offs for exclusion of venous thromboembolism, multi-center IIT initiated by the Pfortmueller group
Important publications
- Hypertonic saline for fluid resuscitation in ICU patients post-cardiac surgery (HERACLES): a double-blind randomized controlled clinical trial. Pfortmueller CA, Kindler M, Schenk N, Messmer AS, Hess B, Jakob L, Wenger S, Waskowski J, Zuercher P, Stoehr F, Jakob SM, Engelberger L, Schefold JC. Intensive Care Med. 2020 Sep;46(9):1683-1695.
- Fluid management in patients undergoing cardiac surgery – effects of an acetate versus lactate buffered balanced infusion solution on hemodynamic stability (HEMACETAT). Pfortmueller CA, Faeh L, Müller M, Eberle B, Jenni H, Zante B, Prazak J, Englberger L, Takala J, Jakob SM. Crit Care. 2019 May 6;23(1):159.
- Normal saline versus a balanced crystalloid for goal-directed perioperative fluid therapy in major abdominal surgery: a double-blind randomized controlled study. Pfortmueller CA, Funk GC, Reiterer C, Schrott A, Zotti O, Kabon B, Fleischmann E, Lindner G. Br J Anaesth. 2018 Feb;120(2):274-283.
- Serum chloride levels in critical illness – the hidden story. Pfortmueller CA, Uehlinger D, von Haehling S, Schefold JC. Intensive Care Med Exp. 2018 Apr 13;6(1):10.
- Fluid overload and mortality in adult critical care patients – a systematic review and meta-analysis of observational studies. Messmer AS, Zingg C, Müller M, Gerber JL, Schefold JC, Pfortmueller CA. Crit Care Med. 2020 Dec;48(12):1862-1870.
- Hypertonic saline in critical illness – a systematic review. Pfortmueller CA, Schefold JC. J Crit Care. 2017 Dec;42:168-177.
- D-dimer to rule out pulmonary embolism in renal insufficiency. Lindner G, Funk GC, Pfortmueller CA, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK, Puig S. Am J Med. 2014 Apr;127(4):343-7.
- Role of D-dimer testing in venous thromboembolism with concomitant renal insufficiency in critical care. Pfortmueller CA, Lindner G, Funk GC, Leichtle AB, Fiedler GM, Schwarz C, Exadaktylos AK. Intensive Care Med. 2017 Mar;43(3):470-471.
- Renal function adjusted D-dimer levels in critically ill patients with suspected thromboembolism. Schefold JC, Gerber JL, Angehrn MC, Müller M, Messmer AS, Leichtle AB, Fiedler GM, Exadaktylos AK, Pfortmueller CA. Crit Care Med. 2020 Apr;48(4):e270-e276.
- Mannitol for the prevention of peri-operative acute kidney injury: a systematic review. Waskowski J, Pfortmueller CA, Erdoes G, Buehlmann R, Messmer AS, Luedi MM, Schmidli J, Schefold JC. Eur J Vasc Endovasc Surg. 2019 Jul;58(1):130-140.
Inselspital, Bern University Hospital
- Department of Emergency Medicine (Prof. A. Exadaktylos, MD, M. Müller, MD, Prof. W. Hautz, MD)
- Department of Anesthesiology and Pain Medicine (Prof. B. Eberle, MD, Prof. G. Erdös, MD, M. Lüdi, MD)
- Department of Cardiovascular Surgery (Prof. L. Engelberger, MD)
- Department of Nephrology and Hypertension (Prof. D. Uehlinger, MD)
- Insel Data Science Center (IDSC)
- Center for Laboratory Medicine (Prof. M. Fiedler, MD, A. Leichtle, MD)
- Department of Infectious Diseases (S. Zimmerli, MD)
National Collaborations
- Intensive Care Unit, Basel University Hospital (Prof. M. Siegemund, MD, A. Hollinger, MD)
- CHUV, Lausanne University Hospital (Prof. M. Berger, MD)
International Collaborations
- Collaboration for Research in Intensive Care (CRIC), Copenhagen – International Network for Research in Critical Care (Prof. A. Perner, MD)
- Medical University of Vienna (G.-Ch. Funk, MD)
- Innovative Clinical Trials Group, University Medical Center Göttingen (UMG) (Prof. S. von Haehling, MD)
- Various sections of the European Society of Intensive Care Medicine (ESICM)