Sandra Jonmarker

Sandra Jonmarker

Affiliated to Research
Visiting address: Södersjukhuset, Sjukhusbacken 14, 11883 Stockholm
Postal address: S1 Klinisk forskning och utbildning, Södersjukhuset, S1 KI SÖS Forskning Anestesi/IVA, 118 83 Stockholm
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About me

  • I was born in Lund. My main interest outside of school was dancing. I stayed
    in Lund for medical school. During my last year at medical school a meet my
    future husband and we decided to move to Kalmar for our internship. After
    almost two years of internship, we moved to Stockholm for our specialist
    training. I have since worked at the clinic of Anesthesiology and Intensive
    Care, Södersjukhuset. We have three wonderful kids aged 9, 7 and 3 years.
    Awarded for best teacher 2013 by medical students
    Primary school, Lerbäckskolan, Lund, Sweden, 1989–1998
    Natural Science, Polhemskolan, Lund, Sweden, 1998–2001
    Mathematics, Chemistry and Biotech, Faculty of Engineering, 2002
    Medical doctor, University of Lund, Sweden, 2003-2009
    Ph D studies, November 2018 - May 2023 at Karolinska Institutet, Stockholm,
    Sweden, “Treatment of coagulopathy in patients with critical COVID-19”.
    Supervised by Maria Cronhjort, Johan Mårtensson, Eva Joelsson-Alm and Martin
    Dahlberg

Research

  • My field of research is mainly sepsis and coagulopathy. When I registered as
    a PhD-student the plan was to write my thesis on sepsis, with the aim to
    improve identification. When the COVID-19 pandemic came it was not possible
    to proceed with the planned studies and COVID-19 became my research priority.
    At my hospital, Södersjukhuset, Stockholm, we treated the largest number of
    patients with critical COVID-19 in Sweden. The main focus for my research is
    the risk for thromboembolism in patients requiring ICU care.
    The findings of the studies included in my thesis are as follows: Patients
    early in the pandemic had an association with a better outcome if treated
    with intensified thromboprophylaxis compared to standard low dosage. If this
    was an effect of the anticoagulation, the anti-inflammatory characteristics
    of low-molecular-weight heparin, a consequence of other unknown temporal
    changes in the treatment of critical COVID-19 during the first wave, or
    random variation, we will never know. Even if glucocorticoids may attenuate
    immunothrombosis in patients with critical COVID-19, no additive effect was
    shown by increasing the dose from 6 to 12 mg dexamethasone. If this means
    glucocorticoids do not mitigate immunothrombosis, or if 6 mg is enough to
    reach a ceiling effect, we will also never know as it is not possible to
    compare glucocorticoids to a placebo, with glucocorticoids already being an
    established mortality-lowering treatment. However, we can conclude, when
    prescribing drugs to a patient with critical COVID-19 and risk for
    thromboembolism and/or bleeding, choosing a high or a low dose of
    glucocorticoids is unlikely to considerably increase or decrease the risk
    further. Low peak values and high trough values of the blood test anti-Factor
    Xa are associated with the clinical outcomes of thromboembolism and bleeding
    in patients with critical COVID-19. These promising results must be
    investigated further, also in other critically ill populations. Since
    thromboprophylaxis is one of the most prescribed treatments for the
    critically ill, an improvement in dosing would have a large effect on
    reducing the number of thromboembolism and bleeding in ICUs worldwide.
    In addition to my COVID-19-studies I have continued with sepsis research. We
    have produced an algorithm to identify septic patients using the electronic
    health records. With this algorithm we are now investigating the true
    incidence of sepsis, type of infections causing sepsis, and which patients
    that have the highest risk of morbidity and mortality of sepsis.
    My main priority now after defending my thesis is to continue to develop my
    skills as a researcher. I therefore wish to broaden my experience by working
    at a new institution. I hope that my skill set may be of help also to other
    researchers. I am open to all fields in intensive care and looking very much
    forward to see and learn new ways to do research with new research colleges.

Teaching

  • Main teacher for internship doctors in Anaesthesia and Intensive care, 2018
    Main teacher for fourth years medical students in Anesthesia and Intensive
    care, 2019–2020
    Repeated lecturer for nurses in specialist training
    Repeated lectures for doctors of other specialities on drugs used for pain
    and sedation

Articles

All other publications

Employments

  • Affiliated to Research, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 2024-2027

Degrees and Education

  • Degree Of Doctor Of Philosophy, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 2024

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