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‘The knowledge and skills of technical physicians are very much needed to make the Intensive Care much better, now and in the future’

On 1 March 2021, the Faculty of S&T welcomed Dirk Donker as professor and holder of the chair in Cardiovascular and Respiratory Physiology (CRPH). In addition to his position at UT, Donker works as an IC physician at the UMC Utrecht. ‘It is my goal and desire to bring the knowledge and skills of technical physicians to the work floor and thus to optimally benefit the patient with the expertise of technical physicians.' 

Dirk Donker studied Medicine in Essen. In order to specialise further, he followed the study programme to become a cardiologist in Maastricht. During this study, Donker did a PhD research in which he investigated the relationship between heart failure and sudden death.

From research to IC physician

‘After many years of research and science, I thought: 'I became a doctor to be an actual doctor in a clinical practice.’ I wanted to work with my expertise and passion: the dynamic aspects of acute and intensive medicine, cardiology, and working with the patients who are the most ill. I was one of the first cardiologists in the Netherlands who therefore made the switch to become an IC physician, at UMC Utrecht, in 2008 and I have been working in one of the most modern IC departments in Europe at UMC Utrecht since 2013. It was a fascinating transition from which I learnt a lot. Where in Maastricht I focused mainly on more conventional cardiac surgery and complex heart failure, in Utrecht I concentrated on supporting patients with an artificial heart and artificial lungs. My expertise in Cardiology and Intensive Care are optimally combined here, focusing on working with patients with severe heart and lung failure. It has become my passion: clinical and scientific. I strongly believe in the value of a very direct link between clinic and science; the questions and problems we face as doctors every day should be a major driver for translational research.’

Much room for improvement in use of technology

‘As an IC physician, I help patients with very complicated syndromes, and I see that as doctors we cannot always fathom everything. It can be very complicated to link all the clinical data of patients. I know for sure that this can be done in a much better way, and technical physicians can play a very important role in this field, exactly where we as conventional doctors sometimes fall short. As doctors, we have traditionally been trained to base our decisions on the results of epidemiological studies, looking at the effect of drug A in 10,000 patients compared with 10,000 other patients receiving drug B. That works fine for chronic, outpatient care, but we can only use such an epidemiological study in the ICU to a very limited extent. Our ICU patients are acutely and seriously ill, have failing lungs, kidneys, a failing heart, and sometimes an infection. An individual patient may have a specific combination of problems that makes comparison with other patients almost impossible. That is why we use a range of monitoring equipment in the ICU, which keeps a close eye on the patient and gives us insight into the individual disease process. So all the tools are available to understand the patient. But our brains are limited: it is difficult to sort, analyse and interpret the complexity and all the data we receive from the equipment. Even though we have a lot of experience and are very passionate, we cannot adequately answer many questions in everyday clinical care. Technology, and technical physicians, must help us as an indispensable part of the team. That is my vision of modern ICU medicine.'

'A digital twin – much more than a good buddy'  

'Since 2014, I have worked together intensively with colleagues in Sweden such as Dr. Michael Broomé, an intensivist at the Astrid Lindgren Children's Hospital at Karolinska University in Stockholm. We both wanted to have a better understanding of how a heart-lung machine for IC use, an ECMO, works best with the patient's own heart and lungs. This is to promote the recovery of these organs as much as possible, while temporarily replacing the patient's organ functions. This has proven to be a very difficult balance to strike. Michael has worked for years to develop a self-regulating computer. This computer is actually a kind of 'computer man', that can be supported by all modern kinds of treatment, including an artificial heart or lung. In the computer, we can simulate patient situations in detail. It then predicts what will happen when you perform action X or Y. But the big challenge is to find out whether this prediction is even correct. If that were the case, you could put a computer next to each patient with which you could test the treatment before applying this to the patient. A kind of 'digital twin'. This kind of research and the application of this technology interests me in particular and has significantly shaped my vision of medicine in the IC.’

Interaction between human and machine not harmonious enough

'The interaction between humans and machines is fascinating. However, this interaction is sometimes difficult to understand. For example, a patient may be under narcosis, on an intravenous drip, a respirator or kidney dialysis and sometimes a heart or lung machine. If you turn up the volume on the heart and lung machine, this also has immediate consequences for the blood pressure and heart rate, which is helpful for blood circulation. But in our field of work, we often look at the first step and not at the effect it has on the patient’s heart and lungs. We still do not pay enough attention to that and it can sometimes have unfavourable effects on other organs. Technical physicians can help us get a better understanding of these processes by using technology that leads to better care of the patient.'

Knowledge from TM must be conveyed to the workplace much more emphatically

'In the clinical workplace, many traditional ways of thinking and working are still used. Not enough use is made of the technological knowledge available here at UT. It is my wish and goal to build a bridge between UT and the clinical work floor. Technical Medicine is a unique study programme, and there is a lot of potential for technical physicians in this very diverse field of work. They can teach doctors how to deal with technology and provide tools to understand and stimulate the interaction of machines with patients.'

All expertise under one roof

In addition to his role as professor, Dirk has been chair of the Cardiovascular and Respiratory Physiology group since 1 March. He also sees opportunities within this group. 'All forms of expertise are united in our group. We have experts in the field of respiration, but also experts in the field of cardiovascular medicine. Because we have expertise on both organ systems, we have a good understanding of how to optimise the interaction between breathing and blood circulation. A practical example: if you turn up the breathing machine, this also has immediate consequences for the heart and blood circulation. This is still not considered enough in the daily routine, because doctors are currently insufficiently guided in the use of all the facets of the technology. I see a great challenge for us as a team to see how we can best co-ordinate policies on breathing and cardiovascular support, with the aim of achieving the best patient care.’

Another practical example is finding out the biological age of patients: 'Patients with more rigid arteries need a different treatment of blood pressure and circulation than patients with more flexible arteries. Unfortunately, at this moment we are not yet able to identify the biological age of a patient objectively and properly. As a result, we only have a sense of biological age, but we cannot adequately anticipate this in the treatment. Thanks to technology, we can map the rigidity of blood vessels. This potentially has major consequences for the treatment of patients on the IC and beyond.’

Recalibration of IC staff

'I am very grateful and happy with my position in the Faculty. From this position, I can help bring the knowledge and skills of technical physicians to the workspace and stimulate our understanding of the interaction between humans and machines much better. And most importantly, I can bring the optimal benefits of technical expertise to the patient. In the past few weeks, I have had many talks with IC managers. It is great to see that many IC managers already employ technical physicians. The time has come for a recalibration of IC staff. There are many young and passionate people both in TM and in our department. So it is time to bring their knowledge, skills, and passion to our workspace!'