The EPIC lab: Laboratory of Emergency, Perioperative and Intensive Care

Our patients 

Critically ill and perioperative patients have inflammatory-driven acute derangement of physiology, leading to cellular oxygen deficiency while ensuing organ failure. At the center of this dysregulation is “the critical unit”, which encompasses the components needed for oxygen transport to tissues.

Concept of “the critical unit”  

The critical unit refers to the part of the microcirculation that involves the perfusion of capillaries with oxygenated red blood cells to ensure cellular energy production in mitochondria to maintain cell survival. Inflammation disrupts these functions by damaging the endothelial glycocalyx and promoting coagulation with microthrombi. These changes impair blood flow, limit oxygen extraction, and impair mitochondrial function, collectively driving tissue hypoxia and organ failure.

Innovative technical solutions to quantify shock

Our lab develops innovative tools that can quantify microcirculatory blood flow, oxygen extraction, and even oxygen levels inside cells. We are translating these techniques from the lab to the bedside, to personalize monitoring of tissue hypoxia and improve shock treatment.

Integrating hemodynamics with hemostasis 

We bridge knowledge domains that are often studied separately. Inflammatory-driven disruption of the endothelial vessel wall promotes coagulation with microthrombi and leads to vessel leakage, collectively impairing blood flow. 
By combining knowledge on inflammatory and hemostatic pathways with advanced hemodynamic monitoring of microcirculation and tissue oxygenation, the EPIC lab pursues a holistic approach to improve treatments of shock.

Topics

Plasma and plasma components for resuscitation of shock.

Fibrinogen variants as a treatment for vascular permeability and disseminated intravascular dissemination 

Anticoagulant strategies for inflammatory-driven disruption of hemostasis in shock.

Mechanisms and therapies for inflammatory-induced anemia during shock.

Novel therapies to treat vasoplegia during shock.

Cellular adaptation and mitochondrial function during and after low oxygen conditions (hypoxia).

Experimental models

1. Human and experimental Endotoxemia
2. Ischemia/Reperfusion
3. Shock with Disseminated Intravascular Coagulation
4. Shock-induced Acute Kidney Injury and Renal Replacement Therapy
5. Cardiogenic shock and Extra Corporeal Membrane Oxygenation 
6. Traumatic shock and hemorrhage
7. Hypoxia and reperfusion in cell culture of liver cells

Equipment and measurements

Phosphorimeter
A tunable pulsed laser-based setup enabling quantitative measurements of in situ oxygen tension in the microcirculation and the mitochondria of tissue cells based on oxygen-dependent quenching of delayed luminescence (phosphorescence and delayed fluorescence respectively).
It measures organ oxygenation with Pd-porhyrine oxygen-quenching phosphorescence decay time measurements

Custom build XY table
This device is places inside a culture incubator and can scan 24 well plates with an optical fiber connected to a phosphorimeter
It measures continuous pericellular oxygen levels and oxygen consumption in confluent liver cell monolayers using oxygen-sensitive dye-labeled microbeads.

Incident Dark Field (IDF) video microscopy
The IDF imaging device consists of a pen-like probe incorporating IDF illumination with a set of high-resolution lenses projecting images of tissue microcirculation.

Cytocam
The CytoCam is a device with a high-tech microscope placed under the tongue to visualize the smallest blood vessels (<100um) and provides quantitative analysis and visual demonstration of blood flow through vessels.

OxyCam
OxyCam is a newly developed IDF device with dual wavelength oximetry allowing quantitively to measure the microvascular hemoglobin oxygen saturation in addition to visualize microvascular blood flow and perfusion with an integrated automated analysis software.

Tissue spectroscopy and doppler 
O2C is a device with an integrated tissue spectroscopy and doppler flow meter. It measures microvascular capillary oxygen saturation, blood velocity and flow of skin or organ microcirculation.

High-resolution respirometry
The Oroboros O2k for measuring oxygen consumption in cell suspensions or isolated mitochondria.
Measurements:
It quantifies mitochondrial oxygen consumption in isolated Peripheral Blood Mononuclear Cells (PBMCs) as a possible measure for systemic mitochondrial function alterations, in kidney, heart and brain.

ROTEM
Rotational thromboelastometry (ROTEM®) is a point of care assessment of the coagulation status of experimental subjects.

Intravital fluorescence microscope
For imaging and quantifying tissue and organ microcirculation and blood cell interaction with labelled platelets, leukocytes or glycocalyx

Molecular techniques 
ELISA (inflammatory cytokines, TNF-a, IL-6, NGAL etc.)
qPCR (gene expression related to mitochondrial dynamics; mitochondrial DNA analysis)

Radiometer ABL850 blood gas analyzer
Blood gases and electrolytes

Collaboration within Erasmus MC

• Clinical departments of the Intensive Care, Anesthesiology, Emergency Medicine and Cardiology 
• Hemostasis Laboratory
• Long COVID research group
• Dutch COVID and Thrombosis Coalition
• Department of Viroscience
• Department of Internal Medicine (Dr. A.J.M. Roks)
• Department of Experimental Cardiology

Collaboration outside of Erasmus MC

• Sanquin Blood Center Amsterdam
• European Trauma Network Overview - Centre For Trauma Sciences
• DIC registry ISTH working group DIC in the ICU - International Society on Thrombosis and Haemostasis, Inc.
• Fraunhofer IZI, Rostock, Dept. Of Extracorporeal Therapy System Department of Extracorporeal Therapy Systems - Fraunhofer IZI
• Department of Anesthesiology, University Medical Center Groningen, The Netherlands

Landsteiner Grant 2026 Bloedserieus over preventie op de IC - Erasmus MC

PPP Innovation Subsidy under the PPP IMPACT Program Call 2025 - “In-situ Mitochondrial Probing of Respiration and Oxygenation for Organ Viability Evaluation”

ZonMW Grant 2025 Mitochondriale oxygenatie als niet-invasieve ambulante test ter objectieve herkenning van PEM

• Prof. Dr. N.P.(Nicole) Juffermans, PhD – Head of the EPIC lab, professor of Translational Intensive Care.
• Dr. E.G. (Bert) Mik, PhD – Head of the EPIC lab, associate professor of Anesthesiology.
• Dr. N.J.H. (Harold) Raat, PhD – Assistant professor 
• Dr. B. (Bulent) Ergin, PhD, Assistant professor
• Dr. F.A. (Floor) Harms, PhD, Researcher
• W. (Wijnie) van Dam, BSc, Biotechnician
• M. (Marielle) van der Kaaij, BSc, Research technician
• P.A.C. (Patricia) Specht, BSc, Research technician
• Drs. D. (Diman) Taha, PhD candidate
• Drs. T.T. (Tarik) Gozden, PhD candidate
• Drs A. (Ashish) O'Varma, PhD candidate
• Drs. T. (Tom) Teeuwen, PhD candidate
• Drs B. (Brent) van Herk, PhD canddiate
• Drs D. (Denyse) Paalvast, PhD candidate
• Drs. A.D. (Alexander) Magan, Research assistant