Reanimatologist Šarūnas Judickas on Research: “One Man in the Field is No Soldier”

“I don’t see myself as a scientist, but rather as a curious doctor,” says Šarūnas Judickas, an anaesthesiologist and reanimatologist at the Vilnius University Hospital Santaros Clinics. He believes that his curiosity encouraged him to attend conferences during his studies, learn about the research being carried out by his colleagues and search for the field that best suited his field of interest. After two years of residency training in haematology, he chose anaesthesiology and critical care. This summer, he also defended his doctoral thesis.

At the end of June, you successfully defended your PhD thesis titled The Impact of Prevalent Risk Factors on the Morbidity and Mortality of Organ System Dysfunction in a Critical Oncohaematology Patient Population. What is it about?

It’s about blood cancer patients during their time in an intensive care unit (ICU). Blood diseases are very serious and life-threatening, and blood cancer patients are at extremely high-risk. We aimed to find out how their condition changes during their treatment in the ICU. These patients are highly susceptible to pathologies, infections, etc., and their admission to the intensive care unit is associated with high mortality. For example, there are certain scenarios where 8 out of 10 patients with blood diseases, who were admitted to intensive care, died. Our study showed a mortality rate of 45%, which is also high—1 in 2 patients die.

However, we did not have any data on the situation in the Santaros Clinics, the largest in the Baltic region in terms of blood marrow transplants. So, we carried out a study to assess how treatment progresses, what the reasons for the higher mortality rate might be, and what we might do to improve this situation.

Our study was observational in nature. We studied all blood cancer patients who were transferred to the ICU, and who had agreed to be followed up. As part of the protocol, we carried out a series of daily tests and monitored how the patient's condition changed during their time in the ICU, and evaluated their tailored treatment. It was also important for us to get the message across that patients with blood diseases are high risk and need to be cared for as early as possible because once they are admitted to the ICU in a slightly more serious condition, their chances of survival are greatly reduced.

What did your study show?

Our study focused mainly on the short-term outcome of reviewing the course of care in the ICU and identifying the determinants of mortality. We then looked at how patients go on living. Our study showed that only 1 in 4 patients survived for one year following treatment in the ICU. This is very low. The mortality rate is highest in the first year, with little change thereafter.

Why does this happen? There are many reasons. Significantly, if a blood disease is well managed, it virtually guarantees a longer life. However, people become very exhausted after receiving treatment in the ICU, and their vital reserves are depleted. They face muscle weakness, nervous fatigue and other issues. Studies show that after one year, no individuals return to their former physical condition. It is a fight for life, like running a marathon, not for a few hours, but for 2–3 weeks. That is why patients do not benefit from the treatment, they are weakened by the very condition that led to their being admitted into intensive care.

However, researchers internationally have found that when a person with blood cancer is transferred from intensive care back onto a ward, their survival rate becomes the same as someone who has never been admitted to intensive care. Interestingly, older patients with blood cancer and admitted to the ICU had exactly the same chance of survival as younger patients. Basically, young patients receive very aggressive treatment, which has complications, and some of the deaths may be related to the treatment of aggressive disease.

When elaborating on your study you often referred to it as “our study” and mentioned the team that worked together with you.

One man in the field is not a soldier. It is no secret that you need a team, a leader, and a lot of help from other colleagues. Part of the team contributed to the practical side of the research, part to the scientific side. I, of course, worked on both of them. It might well be possible to do all the work yourself, but it is difficult and time-consuming. Whereas, with the help of a team, everything is much faster. All the constituent parts are important, without them there would be no machine. The contribution from each one of them is very important.

Now that I have my PhD, I can see that many things could have been done differently, better. Planning is essential, it is important to plan the workflow, to foresee possible interferences, and what might go wrong. It is also about looking for weaknesses in your work, improving them, and even scrapping some of them.

The PhD takes four years. How were the stages of your research distributed during this period?

It all starts with idea generation and planning, which starts a year or two before applying for the PhD. By the time you start your PhD, the research idea has already been refined. Then, in order to carry out research involving patients, it is important to get the approval of a bioethics committee to confirm that your research is necessary, medically and logically sound, ethical, and patient-friendly. Once you have received approval from the bioethics committee to conduct the study, you must also obtain permission from the national data protection authority and the hospital where the study will be conducted. If successful, these formalities can be completed within six months. This preparation period lasted six to eight months, and at the same time, the doctoral studies and examinations were taking place in parallel.

The study itself took two and a half years. At the end of it, we analysed how our study went and whether we achieved our goals. Of course, then came the work of sorting out what was important from the data collected and “translating it all into digestible language”. Some of the data is then presented at conferences and used to write scientific papers. Finally, you can defend your PhD thesis. It’s a long road to the defence stage, and many things are still uncovered during the preparation.

You say that the road towards the doctoral degree is long. Would you take that road again?

It is a very difficult but nurturing journey. You cannot turn back time, but if I were repeating it, I would do a lot of things differently. I would know how to save time and save more energy. First of all, you need to make a very good plan—to get an idea (our study was probably below 10th on the list of ideas that came up), and consider the end result right away. In other words, start from the desired outcome and work from there. For example, I think one of the things that we would do differently, is to limit the scope of the research to a narrower range of things, picking out the most important ones. We collected a lot of data and there were about 130 horizontal lines in the research summary for each subject.
Secondly, I would suggest that we get the help of a statistician as early as possible. We all have some understanding of statistics, we all study it, and we take exams. We have the knowledge, but it is not our field of expertise. Therefore, just as computer repair should be left to those who know how to do it, so it is with statistics.

Thirdly, I recommend that you try to develop a bioethics protocol and start collecting data before you start your PhD. This will allow you to enter with more knowledge, a lighter workload and the opportunity to focus on your main research. Four years is not enough time for some research, so if you did that homework before you started your PhD, it would be much easier afterwards, and the quality might be better.

Finally, as Prof. Rimantas Jankauskas said in his first lecture when my PhD studies started, sometimes you have to take a pragmatic approach to science—the main purpose is to gain new knowledge. I think that you can produce strong science in our country, you just have to do it with a good team. I would suggest not looking at your work as a potential Nobel Prize winner, but understanding that the point of a PhD is to learn how to do research. The best way to learn how to do it is by doing the research yourself. I would also encourage you to network with fellow researchers working in other fields, as more can be achieved through collaboration!

Are you already planning other studies? Which ones are in your immediate plans?

We are very interested in how those with blood cancer who have been treated in intensive care are doing after a longer period of time, say 1–5 years. We want to know about their quality of life, whether they are doing the same job they did before or whether they are living independently.

Our study has revealed that we move patients to the ICU too late. We thought we were moving them early, as soon as their condition deteriorated, but our study showed that it is already too late. That is why we are trying to introduce a scale to help detect patients in serious conditions and move them to intensive care earlier. There is also the idea to create a biobank to store the blood samples taken, for reference in the future. This would create a database that would contribute to the development of science.

Source: VU Faculty of Medicine