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Mielcarek J, Thompson JA, Appavu B, Adelson PD, Reuter-Rice K. Nursing Interventions and Intracranial Pressure Change in Pediatric Patients With Severe Traumatic Brain Injury. Dimens Crit Care Nurs 2024; 43:231-238. [PMID: 39074225 DOI: 10.1097/dcc.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Nursing interventions in the care of pediatric patients with severe traumatic brain injury (TBI) can have a direct effect on intracranial pressure (ICP), yet they have been largely underexplored. Early evidence is therefore needed to describe these relationships and to determine intervention that promotes neuroprotection and recovery. OBJECTIVES The aim of this study was to examine nursing interventions within the first 72 hours of pediatric severe TBI and their effects on ICP. METHOD This is a retrospective review of pediatric patients admitted for severe TBI using a quasi-experimental approach to assess nursing interventions and their association with the patients' ICP values prior to and after each intervention. RESULTS Of the 56 patients who met the inclusion criteria, 3392 intervention events (range, 31-138 events per patient) were reported. Paired t tests conducted for each intervention type found a statistically significant relationship with suctioning and percent change in ICP values (P = .045). All other interventions showed no significant differences. DISCUSSION Standard nursing interventions, specifically suctioning, in pediatric severe TBI may affect ICP and therefore neuroprotection. Further work is needed to better understand the role and timing of nursing interventions and their influence on cerebral hemodynamics so that future TBI guidelines consider nursing care and their impact on brain injury recovery.
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Hermann B, Candia‐Rivera D, Sharshar T, Gavaret M, Diehl J, Cariou A, Benghanem S. Aberrant brain-heart coupling is associated with the severity of post cardiac arrest brain injury. Ann Clin Transl Neurol 2024; 11:866-882. [PMID: 38243640 PMCID: PMC11021613 DOI: 10.1002/acn3.52000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/24/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE To investigate autonomic nervous system activity measured by brain-heart interactions in comatose patients after cardiac arrest in relation to the severity and prognosis of hypoxic-ischemic brain injury. METHODS Strength and complexity of bidirectional interactions between EEG frequency bands (delta, theta, and alpha) and ECG heart rate variability frequency bands (low frequency, LF and high frequency, HF) were computed using a synthetic data generation model. Primary outcome was the severity of brain injury, assessed by (i) standardized qualitative EEG classification, (ii) somatosensory evoked potentials (N20), and (iii) neuron-specific enolase levels. Secondary outcome was the 3-month neurological status, assessed by the Cerebral Performance Category score [good (1-2) vs. poor outcome (3-4-5)]. RESULTS Between January 2007 and July 2021, 181 patients were admitted to ICU for a resuscitated cardiac arrest. Poor neurological outcome was observed in 134 patients (74%). Qualitative EEG patterns suggesting high severity were associated with decreased LF/HF. Severity of EEG changes were proportional to higher absolute values of brain-to-heart coupling strength (p < 0.02 for all brain-to-heart frequencies) and lower values of alpha-to-HF complexity (p = 0.049). Brain-to-heart coupling strength was significantly higher in patients with bilateral absent N20 and correlated with neuron-specific enolase levels at Day 3. This aberrant brain-to-heart coupling (increased strength and decreased complexity) was also associated with 3-month poor neurological outcome. INTERPRETATION Our results suggest that autonomic dysfunctions may well represent hypoxic-ischemic brain injury post cardiac arrest pathophysiology. These results open avenues for integrative monitoring of autonomic functioning in critical care patients.
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Affiliation(s)
- Bertrand Hermann
- Faculté de MédecineUniversité Paris CitéParisFrance
- Medical Intensive Care UnitHEGP Hospital, Assistance Publique ‐ Hôpitaux de Paris‐Centre (APHP.Centre)ParisFrance
- INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP)Université Paris CitéParisFrance
| | - Diego Candia‐Rivera
- Sorbonne Université, Paris Brain Institute (ICM), INRIA, CNRS UMR 722, INSERM U1127, AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
| | - Tarek Sharshar
- Faculté de MédecineUniversité Paris CitéParisFrance
- INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP)Université Paris CitéParisFrance
- GHU Paris Psychiatrie Neurosciences, Service hospitalo‐universitaire de Neuro‐anesthésie réanimationParisFrance
| | - Martine Gavaret
- Faculté de MédecineUniversité Paris CitéParisFrance
- INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP)Université Paris CitéParisFrance
- Neurophysiology and Epileptology DepartmentGHU Paris Psychiatrie et NeurosciencesParisFrance
| | - Jean‐Luc Diehl
- Faculté de MédecineUniversité Paris CitéParisFrance
- Medical Intensive Care UnitHEGP Hospital, Assistance Publique ‐ Hôpitaux de Paris‐Centre (APHP.Centre)ParisFrance
- Université Paris Cité, INSERM, Innovative Therapies in HaemostasisParisFrance
- Biosurgical Research Lab (Carpentier Foundation)ParisFrance
| | - Alain Cariou
- Faculté de MédecineUniversité Paris CitéParisFrance
- Medical Intensive Care UnitCochin Hospital, Assistance Publique ‐ Hôpitaux de Paris‐Centre (APHP‐Centre)ParisFrance
- Paris‐Cardiovascular‐Research‐CenterINSERM U970ParisFrance
| | - Sarah Benghanem
- Faculté de MédecineUniversité Paris CitéParisFrance
- INSERM UMR 1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP)Université Paris CitéParisFrance
- Medical Intensive Care UnitCochin Hospital, Assistance Publique ‐ Hôpitaux de Paris‐Centre (APHP‐Centre)ParisFrance
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Riganello F, Vatrano M, Cortese MD, Tonin P, Soddu A. Central autonomic network and early prognosis in patients with disorders of consciousness. Sci Rep 2024; 14:1610. [PMID: 38238457 PMCID: PMC10796939 DOI: 10.1038/s41598-024-51457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
The central autonomic network (CAN) plays a crucial role in modulating the autonomic nervous system. Heart rate variability (HRV) is a valuable marker for assessing CAN function in disorders of consciousness (DOC) patients. We used HRV analysis for early prognosis in 58 DOC patients enrolled within ten days of hospitalization. They underwent a five-minute electrocardiogram during baseline and acoustic/visual stimulation. The coma recovery scale-revised (CRS-R) was used to define the patient's consciousness level and categorize the good/bad outcome at three months. The high-frequency Power Spectrum Density and the standard deviation of normal-to-normal peaks in baseline, the sample entropy during the stimulation, and the time from injury features were used in the support vector machine analysis (SVM) for outcome prediction. The SVM predicted the patients' outcome with an accuracy of 96% in the training test and 100% in the validation test, underscoring its potential to provide crucial clinical information about prognosis.
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Affiliation(s)
- Francesco Riganello
- Reseach in Advanced Neurorehabilitation, S. Anna Institute, 88900, Crotone, Italy.
| | - Martina Vatrano
- Reseach in Advanced Neurorehabilitation, S. Anna Institute, 88900, Crotone, Italy
| | | | - Paolo Tonin
- Reseach in Advanced Neurorehabilitation, S. Anna Institute, 88900, Crotone, Italy
| | - Andrea Soddu
- Physics & Astronomy Department and Western Institute for Neuroscience, University of Western Ontario, London, ON, Canada
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Association between temporal patterns of baroreflex sensitivity after traumatic brain injury and prognosis: a preliminary study. Neurol Sci 2023; 44:1653-1663. [PMID: 36609622 PMCID: PMC10102132 DOI: 10.1007/s10072-022-06579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) may lead to an increase in intracranial pressure (ICP) as well as impairment of cerebral vascular reactivity and the autonomic nervous system. This study aimed to investigate individual patterns of changes in baroreflex sensitivity (BRS) along with the assessment of pressure reactivity index (PRx) and ICP after TBI. MATERIALS AND METHODS Twenty-nine TBI patients with continuous arterial blood pressure (ABP) and ICP monitoring were included. BRS was calculated using the sequential cross-correlation method. PRx was estimated using slow-wave oscillations of ABP and ICP. Outcome was assessed using the Glasgow Outcome Scale. RESULTS Pooled data analysis of the lower breakpoint during the week that followed TBI revealed that BRS reached a minimum about 2 days after TBI. In patients with good outcome, there was a significant increase in BRS during the 7 days following TBI: rp = 0.21; p = 0.008 and the temporal changes in BRS showed either a "U-shaped" pattern or a gradual increase over time. The BRS value after 1.5 days was found to be a significant predictor of mortality (cut-off BRS = 1.8 ms/mm Hg; AUC = 0.83). In patients with poor outcome, ICP and PRx increased while BRS remained low. CONCLUSIONS We found an association between temporal patterns of BRS and prognosis in the early days following TBI. Further research in a larger cohort of patients is needed to confirm the weight of these preliminary observations for prediction of prognosis in TBI patients.
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Martin S, Du Pont-Thibodeau G, Seely AJE, Emeriaud G, Herry CL, Recher M, Lacroix J, Ducharme-Crevier L. Heart Rate Variability in Children with Moderate and Severe Traumatic Brain Injury: A Prospective Observational Study. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1759877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AbstractThe aim of this study was to assess the feasibility of continuous monitoring of heart rate variability (HRV) in children with traumatic brain injury (TBI) hospitalized in a pediatric intensive care unit (PICU) and collect preliminary data on the association between HRV, neurological outcome, and complications. This is a prospective observational cohort study in a tertiary academic PICU. Children admitted to the PICU ≤24 hours after moderate or severe TBI were included in the study. Children suspected of being brain dead at PICU entry or with a pacemaker were excluded. Children underwent continuous monitoring of electrocardiographic (ECG) waveforms over 7 days post-TBI. HRV analysis was performed retrospectively, using a standardized, validated HRV analysis software (CIMVA). The occurrence of medical complications (“event”: intracranial hypertension, cerebral hypoperfusion, seizure, and cardiac arrest) was prospectively documented. Outcome of children 6 months post-TBI was assessed using the Glasgow Outcome Scale – Extended Pediatric (GOS-E Peds). Fifteen patients were included over a 20-month period. Thirteen patients had ECG recordings available and 4 had >20% of missing ECG data. When ECG was available, HRV calculation was feasible (average 88%; range 70–97%). Significant decrease in overall HRV coefficient of variation and Poincaré SD2 (p < 0.05) at 6 hours post–PICU admission was associated with an unfavorable outcome (defined as GOS-E Peds ≥ 3, or a deterioration of ≥2 points over baseline score). Several HRV metrics exhibited significant and nonsignificant variation in HRV during event. This study demonstrates that it is feasible to monitor HRV in the PICU provided ECG data are available; however, missing ECG data are not uncommon. These preliminary data suggest that altered HRV is associated with unfavorable neurological outcome and in-hospital medical complications. Larger prospective studies are needed to confirm these findings and to explore if HRV offers reliable and clinically useful prediction data that may help clinical decision making.
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Affiliation(s)
- Sophie Martin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Du Pont-Thibodeau
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Andrew J. E. Seely
- Thoracic Surgery & Critical Care Medicine, The Ottawa Hospital, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Guillaume Emeriaud
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | | | - Morgan Recher
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Laurence Ducharme-Crevier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
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Ellingson CJ, Singh J, Ellingson CA, Sirant LW, Krätzig GP, Dorsch KD, Piskorski J, Neary JP. Alterations in Baroreflex Sensitivity and Blood Pressure Variability Following Sport-Related Concussion. Life (Basel) 2022; 12:life12091400. [PMID: 36143435 PMCID: PMC9500648 DOI: 10.3390/life12091400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Current methods to diagnose concussions are subjective and difficult to confirm. A variety of physiological biomarkers have been reported, but with conflicting results. This study assessed heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and systolic blood pressure variability (BPV) in concussed athletes. The assessment consisted of a 5-min seated rest followed by a 5-min (0.1 Hz) controlled breathing protocol. Thirty participants completed baseline assessments. The protocol was repeated during the post-injury acute phase (days one to five). Total (p = 0.02) and low-frequency (p = 0.009) BPV spectral power were significantly decreased during the acute phase of concussion. BRS down-sequence (p = 0.036) and up-sequence (p = 0.05) were significantly increased in the acute phase of concussion, with a trend towards an increased BRS pooled (p = 0.06). Significant decreases in HRV were also found. Acute concussion resulted in altered BRS and BPV dynamics compared to baseline. These findings highlight objective physiological parameters that could aid concussion diagnosis and return-to-play protocols.
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Affiliation(s)
- Chase J. Ellingson
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Jyotpal Singh
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Cody A. Ellingson
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Luke W. Sirant
- College of Medicine, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2, Canada
| | - Gregory P. Krätzig
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Kim D. Dorsch
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Jaroslaw Piskorski
- Institute of Physics, University of Zielona Góra, Licealna 9, 65-417 Zielona Góra, Poland
| | - J. Patrick Neary
- Faculty of Kinesiology & Health Studies, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
- Correspondence: ; Tel.: +1-306-585-4844
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Pearson R, Sheridan CA, Kang K, Brown A, Baham M, Asarnow R, Giza CC, Choe MC. Post-Concussive Orthostatic Tachycardia is Distinct from Postural Orthostatic Tachycardia Syndrome (POTS) in Children and Adolescents. Child Neurol Open 2022; 9:2329048X221082753. [PMID: 35647216 PMCID: PMC9136088 DOI: 10.1177/2329048x221082753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 02/03/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Orthostatic tachycardia (OT) affects some patients after
concussion/mild traumatic brain injury (mTBI). In this study, we sought to
identify the factors associated with increased risk for OT in patients with
mTBI. Methods: We conducted a retrospective review of 268 patients
(8-25 years) with mTBI/concussion to determine the prevalence of OT, defined as
orthostatic heart rate change ≥40 bpm for those ≤19 years of age and ≥30 bpm on
active standing test for those >19 years of age. Results: Among
the study population, 7% (n = 19) exhibited post-concussive OT. The only
significant difference between OT and non-OT groups was that history of prior
concussion was more prevalent in the OT group. Conclusion: A
substantial subset (7%) of concussion clinic patients exhibit OT. While POTS
literature describes female and adolescent predominance, post-concussive OT had
similar prevalence across age and gender groups in this study, suggesting that
it may be distinct from POTS.
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Affiliation(s)
- Rachel Pearson
- UC-Los Angeles Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, Los Angeles, CA, USA
- Division of Pediatric Neurology, UC-Los Angeles Mattel Children’s Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
- Children’s Hospital Orange County, Orange, California, USA
| | - Christopher A. Sheridan
- UC-Los Angeles Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, Los Angeles, CA, USA
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kaylee Kang
- UC-Los Angeles Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, Los Angeles, CA, USA
| | - Anne Brown
- UC-Los Angeles Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, Los Angeles, CA, USA
| | - Michael Baham
- UC-Los Angeles Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, Los Angeles, CA, USA
- UC-Irvine School of Medicine, Irvine, CA, USA
| | - Robert Asarnow
- Psychiatry and Biobehavioral Science, University of California-Los Angeles, Los Angeles, CA, USA
| | - Christopher C. Giza
- UC-Los Angeles Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, Los Angeles, CA, USA
- Division of Pediatric Neurology, UC-Los Angeles Mattel Children’s Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Meeryo C. Choe
- UC-Los Angeles Steve Tisch BrainSPORT Program, UCLA Easton Clinic for Brain Health, Los Angeles, CA, USA
- Division of Pediatric Neurology, UC-Los Angeles Mattel Children’s Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
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Flower A, Vasiliu D, Zhu T, Andris R, Abubakar M, Fairchild K, Zanelli S, Matsumoto J, Mathur AM, Delos J, Vesoulis Z. Low Variability of Blood Pressure Predicts Abnormal Electroencephalogram in Infants with Hypoxic Ischemic Encephalopathy. Am J Perinatol 2022; 39:288-297. [PMID: 32819015 PMCID: PMC7895863 DOI: 10.1055/s-0040-1715822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate-severe grade EEG at 48 hours. Standardized signal preprocessing was used; the power spectral density was computed without interpolation. Multivariate binary logistic regression was used to identify which MABP time and frequency domain metrics provided improved predictive power for adverse outcomes compared with standard clinical predictors (5-minute Apgar score and cord pH) using receiver operator characteristic analysis. RESULTS Ninety-one infants met inclusion criteria. The mean gestational age was 38.4 ± 1.8 weeks, the mean birth weight was 3,260 ± 591 g, 52/91 (57%) of infants were males, the mean cord pH was 6.95 ± 0.21, and 10/91 (11%) of infants died. At 48 hours, 58% of infants had normal or mildly abnormal EEG background and 42% had moderate or severe EEG backgrounds. Clinical predictor variables (10-minute Apgar score, Sarnat stage, and cord pH) were modestly predictive of 48 hours EEG outcome with area under curve (AUC) of 0.66 to 0.68. A composite model of clinical and optimal time- and frequency-domain blood pressure variability had a substantially improved AUC of 0.86. CONCLUSION Time- and frequency-domain blood pressure variability biomarkers offer a substantial improvement in prediction of later adverse EEG outcomes over perinatal clinical variables in a two-center cohort of infants with HIE. KEY POINTS · Early outcome prediction in HIE is suboptimal.. · Patterns in blood pressure physiology may be predictive of short-term outcomes.. · Early time- and frequency-domain measures of blood pressure variability predict short-term EEG outcomes in HIE infants better than perinatal factors alone..
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Affiliation(s)
- Abigail Flower
- School of Data Science, University of Virginia, Charlottesville, VA
| | - Daniel Vasiliu
- Department of Mathematics, College of William & Mary, Williamsburg, VA
| | - Tianrui Zhu
- Department of Mathematics, College of William & Mary, Williamsburg, VA
| | - Robert Andris
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Maryam Abubakar
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Karen Fairchild
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Santina Zanelli
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Julie Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - Amit M. Mathur
- Division of Neonatal-Perinatal Medicine, Saint Louis University, St. Louis, MO
| | - John Delos
- Department of Physics, College of William & Mary, Williamsburg, VA
| | - Zachary Vesoulis
- Department of Pediatrics, Washington University St. Louis, St. Louis, MO
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Fedriga M, Czigler A, Nasr N, Zeiler FA, Park S, Donnelly J, Papaioannou V, Frisvold SK, Wolf S, Rasulo F, Sykora M, Smielewski P, Czosnyka M. Autonomic Nervous System Activity during Refractory Rise in Intracranial Pressure. J Neurotrauma 2021; 38:1662-1669. [PMID: 33280491 PMCID: PMC8336253 DOI: 10.1089/neu.2020.7091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Refractory intracranial hypertension (RIH) is a dramatic increase in intracranial pressure (ICP) that cannot be controlled by treatment. Recent reports suggest that the autonomic nervous system (ANS) activity may be altered during changes in ICP. Our study aimed to assess ANS activity during RIH and the causal relationship between rising in ICP and autonomic activity. We reviewed retrospectively 24 multicenter (Cambridge, Tromso, Berlin) patients in whom RIH developed as a pre-terminal event after acute brain injury (ABI). They were monitored with ICP, arterial blood pressure (ABP), and electrocardiography (ECG) using ICM+ software. Parameters reflecting autonomic activity were computed in time and frequency domain through the measurement of heart rate variability (HRV) and baroreflex sensitivity (BRS). Our results demonstrated that a rise in ICP was associated to a significant rise in HRV and BRS with a higher significance level in the high-frequency HRV (p < 0.001). This increase was followed by a significant decrease in HRV and BRS above the upper-breakpoint of ICP where ICP pulse-amplitude starts to decrease whereas the mean ICP continues to rise. Temporality measured with a Granger test suggests a causal relationship from ICP to ANS. The above results suggest that a rise in ICP interacts with ANS activity, mainly interfacing with the parasympathetic-system. The ANS seems to react to the rise in ICP with a response possibly focused on maintaining the cerebrovascular homeostasis. This happens until the critical threshold of ICP is reached above which the ANS variables collapse, probably because of low perfusion of the brain and the central autonomic network.
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Affiliation(s)
- Marta Fedriga
- Brain Division of Neurosurgery, Department of Clinical Neurosciences, Physics Laboratory, University of Cambridge, Cambridge, United Kingdom
- Department of Anaesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Andras Czigler
- Brain Division of Neurosurgery, Department of Clinical Neurosciences, Physics Laboratory, University of Cambridge, Cambridge, United Kingdom
- Department of Neurosurgery and Szentagothai Research Center, University of Pecs, Pecs, Hungary
| | - Nathalie Nasr
- Unitè de Neurologie Vasculaire, CHU de Toulouse, Universitè de Toulouse, Toulouse, France
| | - Frederick. A. Zeiler
- Department of Surgery, Faculty of Engineering, University of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, Faculty of Engineering, University of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Biomedical Engineering, Faculty of Engineering, University of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Soojin Park
- Department of Neurology, Division of Hospitalist and Critical Care Neurology, Columbia University, New York, New York, USA
| | - Joseph Donnelly
- Department of Anaesthesiology, University of Auckland, Aukland, New Zealand
| | - Vasilios Papaioannou
- University Hospital of Alexandroupolis, Intensive Care Unit, Democritus University of Thrace, Alexandroupolis, Greece
| | - Shirin K Frisvold
- Department of Intensive Care, University Hospital of North Norway, UiT The Arctic University of Norway, Tromso, Norway
| | - Stephan Wolf
- Department of Neurosurgery, Charite Hospital, Berlin, Germany
| | - Frank Rasulo
- Department of Anaesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Marek Sykora
- Department of Neurology, St. John's Hospital Vienna, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Peter Smielewski
- Brain Division of Neurosurgery, Department of Clinical Neurosciences, Physics Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Marek Czosnyka
- Brain Division of Neurosurgery, Department of Clinical Neurosciences, Physics Laboratory, University of Cambridge, Cambridge, United Kingdom
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10
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Ma Y, Zhou J, Kavousi M, Lipsitz LA, Mattace-Raso F, Westerhof BE, Wolters FJ, Wu JW, Manor B, Ikram MK, Goudsmit J, Hofman A, Ikram MA. Lower complexity and higher variability in beat-to-beat systolic blood pressure are associated with elevated long-term risk of dementia: The Rotterdam Study. Alzheimers Dement 2021; 17:1134-1144. [PMID: 33860609 DOI: 10.1002/alz.12288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We hypothesized that subclinical disruption in blood pressure (BP) dynamics, captured by lower complexity and higher variability, may contribute to dementia risk, above and beyond BP levels. METHODS This prospective cohort study followed 1835 older adults from 1997 to 2016, with BP complexity quantified by sample entropy and BP variability quantified by coefficient of variation using beat-to-beat BP measured at baseline. RESULTS Three hundred thirty-four participants developed dementia over 20 years. Reduced systolic BP (SBP) complexity was associated with a higher risk of dementia (hazard ratio [HR] comparing extreme quintiles: 1.55; 95% confidence interval [CI]: 1.09-2.20). Higher SBP variability was also associated with a higher risk of dementia (HR comparing extreme quintiles: 1.57; 95% CI: 1.11-2.22. These findings were observed after adjusting for age, sex, apolipoprotein E (APOE) genotype, mean SBP, and other confounding factors. DISCUSSIONS Our findings suggest that lower complexity and higher variability of beat-to-beat SBP are potential novel risk factors or biomarkers for dementia.
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Affiliation(s)
- Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Junhong Zhou
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Julia W Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Brad Manor
- Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, USA
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jaap Goudsmit
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, USA.,Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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11
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Lee H, Jeon SB, Lee KS. Continuous heart rate variability and electroencephalography monitoring in severe acute brain injury: a preliminary study. Acute Crit Care 2021; 36:151-161. [PMID: 33730778 PMCID: PMC8182164 DOI: 10.4266/acc.2020.00703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Decreases in heart rate variability have been shown to be associated with poor outcomes in severe acute brain injury. However, it is unknown whether the changes in heart rate variability precede neurological deterioration in such patients. We explored the changes in heart rate variability measured by electrocardiography in patients who had neurological deterioration following severe acute brain injury, and examined the relationship between heart rate variability and electroencephalography parameters. Methods Retrospective analysis of 25 patients who manifested neurological deterioration after severe acute brain injury and underwent simultaneous electroencephalography plus electrocardiography monitoring. Results Eighteen electroencephalography channels and one simultaneously recorded electrocardiography channel were segmented into epochs of 120-second duration and processed to compute 10 heart rate variability parameters and three quantitative electroencephalography parameters. Raw electroencephalography of the epochs was also assessed by standardized visual interpretation and categorized based on their background abnormalities and ictalinterictal continuum patterns. The heart rate variability and electroencephalography parameters showed consistent changes in the 2-day period before neurological deterioration commenced. Remarkably, the suppression ratio and background abnormality of the electroencephalography parameters had significant reverse correlations with all heart rate variability parameters. Conclusions We observed a significantly progressive decline in heart rate variability from the day before the neurological deterioration events in patients with severe acute brain injury were first observed.
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Affiliation(s)
- Hyunjo Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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Cardiorespiratory synchronisation and systolic blood pressure correlation of peripheral arterial stiffness during endoscopic thoracic sympathectomy. Sci Rep 2021; 11:5966. [PMID: 33727620 PMCID: PMC7966741 DOI: 10.1038/s41598-021-85299-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/23/2021] [Indexed: 11/08/2022] Open
Abstract
Muscle sympathetic nerve activity (MSNA) is known as an effective measure to evaluate peripheral sympathetic activity; however, it requires invasive measurement with the microneurography method. In contrast, peripheral arterial stiffness affected by MSNA is a measure that allows non-invasive evaluation of mechanical changes of arterial elasticity. This paper aims to clarify the features of peripheral arterial stiffness to determine whether it inherits MSNA features towards non-invasive evaluation of its activity. To this end, we propose a method to estimate peripheral arterial stiffness [Formula: see text] at a high sampling rate. Power spectral analysis of the estimated [Formula: see text] was then performed on data acquired from 15 patients ([Formula: see text] years) who underwent endoscopic thoracic sympathectomy. We examined whether [Formula: see text] exhibited the features of MSNA where its frequency components synchronise with heart and respiration rates and correlates with the low-frequency component of systolic blood pressure. Regression analysis revealed that the local peak frequency in the range of heartbeat frequency highly correlate with the heart rate ([Formula: see text], [Formula: see text]) where the regression slope was approximately 1 and intercept was approximately 0. Frequency analysis then found spectral peaks of [Formula: see text] approximately 0.2 Hz that correspond to the respiratory cycle. Finally, cross power spectral analysis showed a significant magnitude squared coherence between [Formula: see text] and systolic blood pressure in the frequency band from 0.04 to 0.2 Hz. These results indicate that [Formula: see text] inherits the features observed in MSNA that require invasive measurements, and thus [Formula: see text] can be an effective non-invasive substitution for MSNA measure.
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13
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Bajić D, Mišić N, Škorić T, Japundžić-Žigon N, Milovanović M. On Entropy of Probability Integral Transformed Time Series. ENTROPY (BASEL, SWITZERLAND) 2020; 22:E1146. [PMID: 33286915 PMCID: PMC7597301 DOI: 10.3390/e22101146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/27/2020] [Accepted: 10/09/2020] [Indexed: 11/17/2022]
Abstract
The goal of this paper is to investigate the changes of entropy estimates when the amplitude distribution of the time series is equalized using the probability integral transformation. The data we analyzed were with known properties-pseudo-random signals with known distributions, mutually coupled using statistical or deterministic methods that include generators of statistically dependent distributions, linear and non-linear transforms, and deterministic chaos. The signal pairs were coupled using a correlation coefficient ranging from zero to one. The dependence of the signal samples is achieved by moving average filter and non-linear equations. The applied coupling methods are checked using statistical tests for correlation. The changes in signal regularity are checked by a multifractal spectrum. The probability integral transformation is then applied to cardiovascular time series-systolic blood pressure and pulse interval-acquired from the laboratory animals and represented the results of entropy estimations. We derived an expression for the reference value of entropy in the probability integral transformed signals. We also experimentally evaluated the reliability of entropy estimates concerning the matching probabilities.
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Affiliation(s)
- Dragana Bajić
- Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Nataša Mišić
- Research and Development Institute Lola Ltd., 11000 Belgrade, Serbia;
| | - Tamara Škorić
- Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
| | | | - Miloš Milovanović
- Mathematical Institute of the Serbian Academy of Sciences and Arts, 11000 Beograd, Serbia;
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14
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Gao L, Smielewski P, Li P, Czosnyka M, Ercole A. Signal Information Prediction of Mortality Identifies Unique Patient Subsets after Severe Traumatic Brain Injury: A Decision-Tree Analysis Approach. J Neurotrauma 2020; 37:1011-1019. [PMID: 31744382 PMCID: PMC7175619 DOI: 10.1089/neu.2019.6631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Nonlinear physiological signal features that reveal information content and causal flow have recently been shown to be predictors of mortality after severe traumatic brain injury (TBI). The extent to which these features interact together, and with traditional measures to describe patients in a clinically meaningful way remains unclear. In this study, we incorporated basic demographics (age and initial Glasgow Coma Scale [GCS]) with linear and non-linear signal information based features (approximate entropy [ApEn], and multivariate conditional Granger causality [GC]) to evaluate their relative contributions to mortality using cardio-cerebral monitoring data from 171 severe TBI patients admitted to a single neurocritical care center over a 10 year period. Beyond linear modelling, we employed a decision tree analysis approach to define a predictive hierarchy of features. We found ApEn (p = 0.009) and GC (p = 0.004) based features to be independent predictors of mortality at a time when mean intracranial pressure (ICP) was not. Our combined model with both signal information-based features performed the strongest (area under curve = 0.86 vs. 0.77 for linear features only). Although low "intracranial" complexity (ApEn-ICP) outranked both age and GCS as crucial drivers of mortality (fivefold increase in mortality where ApEn-ICP <1.56, 36.2% vs. 7.8%), decision tree analysis revealed clear subsets of patient populations using all three predictors. Patients with lower ApEn-ICP who were >60 years of age died, whereas those with higher ApEn-ICP and GCS ≥5 all survived. Yet, even with low initial intracranial complexity, as long as patients maintained robust GC and "extracranial" complexity (ApEn of mean arterial pressure), they all survived. Incorporating traditional linear and novel, non-linear signal information features, particularly in a framework such as decision trees, may provide better insight into "health" status. However, caution is required when interpreting these results in a clinical setting prior to external validation.
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Affiliation(s)
- Lei Gao
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
| | - Peter Smielewski
- Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts
| | - Marek Czosnyka
- Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Ari Ercole
- Neurosciences Critical Care Unit, Department of Anesthesia, University of Cambridge Hills Road, Cambridge, United Kingdom
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15
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Neary JP, Dudé CM, Singh J, Len TK, Bhambhani YN. Pre-frontal Cortex Oxygenation Changes During Aerobic Exercise in Elite Athletes Experiencing Sport-Related Concussion. Front Hum Neurosci 2020; 14:35. [PMID: 32116614 PMCID: PMC7028689 DOI: 10.3389/fnhum.2020.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/23/2020] [Indexed: 12/28/2022] Open
Abstract
Aims: Recent research suggests that aerobic exercise can be performed safely within the first week following a concussion injury and that early initiation of exercise may speed recovery. To better understand the physiological changes during a concussion, we tested the hypothesis that mild-to-intense exercise testing can be performed within days immediately following injury, and can be used to discern differences between the concussed and normal healthy state. Thus, the purpose was to observe the cerebral hemodynamic responses to incremental exercise testing performed acutely post-concussion in high-performance athletes. Methods: This study was a within- and between-experimental design, with seven male university ice hockey teams participating. A subgroup of five players acted as control subjects (CON) and was tested at the same time as the 14 concussed (mTBI) players on Day 2, 4, and 7 post-concussion. A 5-min resting baseline and 5-min exercise bouts of mild (EX1), moderate (EX2), and high (EX3) intensity exercise were performed on a cycle ergometer. Near-infrared spectroscopy was used to monitor pre-frontal cortex oxy-haemoglobin (HbO2), deoxy-haemoglobin (HHb), and total blood volume (tHb) changes. Results: ANOVA compared differences between testing days and groups, and although large percentage changes in HbO2 (20-30%), HHb (30-40%), and tHb (30-40%) were recorded, no significant (p ≤ 0.05) differences in cerebral hemodynamics occurred between mTBI vs. CON during aerobic exercise testing on any day post-injury. Furthermore, there was a linear relationship between exercise intensity vs. cerebral hemodynamics during testing for each day (r 2 = 0.83-0.99). Conclusion: These results demonstrate two novel findings: (1) mild-to-intense aerobic exercise testing can be performed safely as early as Day 2 post-concussion injury in a controlled laboratory environment; and (2) evidence-based objective measures such as cerebral hemodynamics can easily be collected using near-infrared spectroscopy (NIRS) to monitor physiological changes during the first-week post-injury. This research has important implications for monitoring physiological recovery post-injury and establishing new rehabilitation guidelines.
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Affiliation(s)
- J. Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | | | - Jyotpal Singh
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - Trevor K. Len
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - Yagesh N. Bhambhani
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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16
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Crouzet C, Wilson RH, Lee D, Bazrafkan A, Tromberg BJ, Akbari Y, Choi B. Dissociation of Cerebral Blood Flow and Femoral Artery Blood Pressure Pulsatility After Cardiac Arrest and Resuscitation in a Rodent Model: Implications for Neurological Recovery. J Am Heart Assoc 2020; 9:e012691. [PMID: 31902319 PMCID: PMC6988151 DOI: 10.1161/jaha.119.012691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Impaired neurological function affects 85% to 90% of cardiac arrest (CA) survivors. Pulsatile blood flow may play an important role in neurological recovery after CA. Cerebral blood flow (CBF) pulsatility immediately, during, and after CA and resuscitation has not been investigated. We characterized the effects of asphyxial CA on short‐term (<2 hours after CA) CBF and femoral arterial blood pressure (ABP) pulsatility and studied their relationship to cerebrovascular resistance (CVR) and short‐term neuroelectrical recovery. Methods and Results Male rats underwent asphyxial CA followed by cardiopulmonary resuscitation. A multimodal platform combining laser speckle imaging, ABP, and electroencephalography to monitor CBF, peripheral blood pressure, and brain electrophysiology, respectively, was used. CBF and ABP pulsatility and CVR were assessed during baseline, CA, and multiple time points after resuscitation. Neuroelectrical recovery, a surrogate for neurological outcome, was assessed using quantitative electroencephalography 90 minutes after resuscitation. We found that CBF pulsatility differs significantly from baseline at all experimental time points with sustained deficits during the 2 hours of postresuscitation monitoring, whereas ABP pulsatility was relatively unaffected. Alterations in CBF pulsatility were inversely correlated with changes in CVR, but ABP pulsatility had no association to CVR. Interestingly, despite small changes in ABP pulsatility, higher ABP pulsatility was associated with worse neuroelectrical recovery, whereas CBF pulsatility had no association. Conclusions Our results reveal, for the first time, that CBF pulsatility and CVR are significantly altered in the short‐term postresuscitation period after CA. Nevertheless, higher ABP pulsatility appears to be inversely associated with neuroelectrical recovery, possibly caused by impaired cerebral autoregulation and/or more severe global cerebral ischemia.
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Affiliation(s)
- Christian Crouzet
- Beckman Laser Institute and Medical Clinic Irvine CA.,Department of Biomedical Engineering University of California Irvine CA.,University of California, Irvine Irvine CA
| | - Robert H Wilson
- Beckman Laser Institute and Medical Clinic Irvine CA.,University of California, Irvine Irvine CA
| | - Donald Lee
- Department of Neurology University of California Irvine CA.,University of California, Irvine Irvine CA
| | - Afsheen Bazrafkan
- Department of Neurology University of California Irvine CA.,University of California, Irvine Irvine CA
| | - Bruce J Tromberg
- Beckman Laser Institute and Medical Clinic Irvine CA.,Department of Biomedical Engineering University of California Irvine CA.,Department of Surgery University of California Irvine CA.,University of California, Irvine Irvine CA
| | - Yama Akbari
- Beckman Laser Institute and Medical Clinic Irvine CA.,Department of Neurology University of California Irvine CA.,University of California, Irvine Irvine CA
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic Irvine CA.,Department of Biomedical Engineering University of California Irvine CA.,Department of Surgery University of California Irvine CA.,Edwards Lifesciences Center for Advanced Cardiovascular Technology Irvine CA.,University of California, Irvine Irvine CA
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17
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Riganello F, Larroque SK, Di Perri C, Prada V, Sannita WG, Laureys S. Measures of CNS-Autonomic Interaction and Responsiveness in Disorder of Consciousness. Front Neurosci 2019; 13:530. [PMID: 31293365 PMCID: PMC6598458 DOI: 10.3389/fnins.2019.00530] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
Neuroimaging studies have demonstrated functional interactions between autonomic (ANS) and brain (CNS) structures involved in higher brain functions, including attention and conscious processes. These interactions have been described by the Central Autonomic Network (CAN), a concept model based on the brain-heart two-way integrated interaction. Heart rate variability (HRV) measures proved reliable as non-invasive descriptors of the ANS-CNS function setup and are thought to reflect higher brain functions. Autonomic function, ANS-mediated responsiveness and the ANS-CNS interaction qualify as possible independent indicators for clinical functional assessment and prognosis in Disorders of Consciousness (DoC). HRV has proved helpful to investigate residual responsiveness in DoC and predict clinical recovery. Variability due to internal (e.g., homeostatic and circadian processes) and environmental factors remains a key independent variable and systematic research with this regard is warranted. The interest in bidirectional ANS-CNS interactions in a variety of physiopathological conditions is growing, however, these interactions have not been extensively investigated in DoC. In this brief review we illustrate the potentiality of brain-heart investigation by means of HRV analysis in assessing patients with DoC. The authors' opinion is that this easy, inexpensive and non-invasive approach may provide useful information in the clinical assessment of this challenging patient population.
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Affiliation(s)
- Francesco Riganello
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
- S. Anna Institute, Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Valeria Prada
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences, Polyclinic Hospital San Martino IRCCS, University of Genoa, Genoa, Italy
| | - Walter G. Sannita
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal/Child Sciences, Polyclinic Hospital San Martino IRCCS, University of Genoa, Genoa, Italy
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, GIGA Institute, University Hospital of Liège, Liège, Belgium
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18
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Li P. EZ Entropy: a software application for the entropy analysis of physiological time-series. Biomed Eng Online 2019; 18:30. [PMID: 30894180 PMCID: PMC6425722 DOI: 10.1186/s12938-019-0650-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/13/2019] [Indexed: 01/04/2023] Open
Abstract
Background Entropy analysis has been attracting increasing attentions in the recent two or three decades. It assesses complexity, or irregularity, of time-series which is extraordinarily relevant to physiology and diseases as demonstrated by tremendous studies. However, the complexity can hardly be appreciated by traditional methods including time-, frequency-domain analysis, and time-frequency analysis that are the common built-in options in commercialized measurement and statistical software. To facilitate the entropy analysis of physiological time-series, a new software application, namely EZ Entropy, was developed and introduced in this article. Results EZ Entropy was developed in MATLAB® environment. It was programmed in an object-oriented style and was constructed with a graphical user interface. EZ Entropy is easy to operate through its compact graphical interface, thus allowing researchers without knowledge of programming like clinicians and physiologists to perform such kind of analysis. Besides, it offers various settings to meet different analysis needs including (1) processing single data recording, (2) batch processing multiple data files, (3) sliding window calculations, (4) recall, (5) displaying intermediate data and final results, (6) adjusting input parameters, and (7) exporting calculation results after the run or in real-time during the analysis. The analysis results could be exported, either manually or automatically, to comma-separated ASCII files, thus being compatible to and easily imported into the common statistical analysis software. Code-wise, EZ Entropy is object-oriented, thus being quite easy to maintain and extend. Conclusions EZ Entropy is a user-friendly software application to perform the entropy analysis of time-series, as well as to simplify and to speed up this useful analysis. Electronic supplementary material The online version of this article (10.1186/s12938-019-0650-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peng Li
- School of Control Science and Engineering, Shandong University, 17923 Jingshi Road, Jinan, 250061, Shandong, People's Republic of China.
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19
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Hasen M, Almojuela A, Zeiler FA. Autonomic Dysfunction and Associations with Functional and Neurophysiological Outcome in Moderate/Severe Traumatic Brain Injury: A Scoping Review. J Neurotrauma 2019; 36:1491-1504. [PMID: 30343625 DOI: 10.1089/neu.2018.6073] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The quantification and objective documentation of autonomic dysfunction in traumatic brain injury (TBI) is neither well studied nor extensively validated. Most of the descriptions of autonomic dysfunction in the literature are in the form of vague non-specific clinical manifestations. Few studies propose the use of objective measures of assessing the extent of autonomic dysfunction to link them to the outcome of TBI. Our goal was to perform a scoping systematic review of the literature on the objective documentation of autonomic dysfunction in terms of functional and physiological variables to be linked to outcome of TBI. PubMed/MEDLINE®, BIOSIS, Scopus, Embase, Cochrane Libraries, and Global Health databases were searched. Two reviewers independently screened the results. Full texts for citations passing this initial screen were obtained. Inclusion and exclusion criteria were applied to each article to obtain final articles for review. The initial search yielded 2619 citations. Of 69 articles selected for final review, 14 were chosen based on the inclusion and exclusion criteria and are included in the results of this article. 9 of these articles assessed autonomic dysfunction using functional variables and 7 assessed autonomic dysfunction using physiological variables. Some studies included both functional and physiological variables. Of the nine studies linking autonomic dysfunction to functional variables, nine included heart rate variability (HRV), three included baroreflex sensitivity (BRS), and two included blood pressure variability (BPV). A total of 2714 adult patients were studied. Although the nature of association between autonomic dysfunction and outcome is unclear, the objective quantification of autonomic dysfunction seems to be associated with global patient outcome and other neurophysiological measures. Further studies are needed to validate its use and explore the underlying molecular mechanisms of the described associations.
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Affiliation(s)
- Mohammed Hasen
- 1 Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,2 Department of Neurosurgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Alysa Almojuela
- 1 Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Frederick A Zeiler
- 1 Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,3 Clinician Investigator Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,4 Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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20
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Riganello F, Larroque SK, Bahri MA, Heine L, Martial C, Carrière M, Charland-Verville V, Aubinet C, Vanhaudenhuyse A, Chatelle C, Laureys S, Di Perri C. A Heartbeat Away From Consciousness: Heart Rate Variability Entropy Can Discriminate Disorders of Consciousness and Is Correlated With Resting-State fMRI Brain Connectivity of the Central Autonomic Network. Front Neurol 2018; 9:769. [PMID: 30258400 PMCID: PMC6145008 DOI: 10.3389/fneur.2018.00769] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Disorders of consciousness are challenging to diagnose, with inconsistent behavioral responses, motor and cognitive disabilities, leading to approximately 40% misdiagnoses. Heart rate variability (HRV) reflects the complexity of the heart-brain two-way dynamic interactions. HRV entropy analysis quantifies the unpredictability and complexity of the heart rate beats intervals. We here investigate the complexity index (CI), a score of HRV complexity by aggregating the non-linear multi-scale entropies over a range of time scales, and its discriminative power in chronic patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS), and its relation to brain functional connectivity. Methods: We investigated the CI in short (CIs) and long (CIl) time scales in 14 UWS and 16 MCS sedated. CI for MCS and UWS groups were compared using a Mann-Whitney exact test. Spearman's correlation tests were conducted between the Coma Recovery Scale-revised (CRS-R) and both CI. Discriminative power of both CI was assessed with One-R machine learning model. Correlation between CI and brain connectivity (detected with functional magnetic resonance imagery using seed-based and hypothesis-free intrinsic connectivity) was investigated using a linear regression in a subgroup of 10 UWS and 11 MCS patients with sufficient image quality. Results: Higher CIs and CIl values were observed in MCS compared to UWS. Positive correlations were found between CRS-R and both CI. The One-R classifier selected CIl as the best discriminator between UWS and MCS with 90% accuracy, 7% false positive and 13% false negative rates after a 10-fold cross-validation test. Positive correlations were observed between both CI and the recovery of functional connectivity of brain areas belonging to the central autonomic networks (CAN). Conclusion: CI of MCS compared to UWS patients has high discriminative power and low false negative rate at one third of the estimated human assessors' misdiagnosis, providing an easy, inexpensive and non-invasive diagnostic tool. CI reflects functional connectivity changes in the CAN, suggesting that CI can provide an indirect way to screen and monitor connectivity changes in this neural system. Future studies should assess the extent of CI's predictive power in a larger cohort of patients and prognostic power in acute patients.
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Affiliation(s)
- Francesco Riganello
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Research in Advanced NeuroRehabilitation, Istituto S. Anna, Crotone, Italy
| | - Stephen Karl Larroque
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Mohamed Ali Bahri
- GIGA-Cyclotron Research Center in vivo Imaging, University of Liege, Liege, Belgium
| | - Lizette Heine
- Centre de Recherche en Neurosciences, Inserm U1028 - CNRS UMR5292, University of Lyon 1, Bron, France
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | | | - Charlène Aubinet
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Sensation & Perception Research Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Camille Chatelle
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
| | - Carol Di Perri
- Coma Science Group, GIGA-Consciousness, University & Hospital of Liege, Liege, Belgium
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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21
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Szabo J, Smielewski P, Czosnyka M, Jakubicek S, Krebs S, Siarnik P, Sykora M. Heart rate variability is associated with outcome in spontaneous intracerebral hemorrhage. J Crit Care 2018; 48:85-89. [PMID: 30176528 DOI: 10.1016/j.jcrc.2018.08.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Autonomic imbalance as measured by heart rate variability (HRV) has been associated with poor outcome after stroke. Observations on HRV changes in intracerebral hemorrhage (ICH) are scarce. Here, we aimed to investigate HRV in ICH as compared to a control group and to explore associations with stroke severity, hemorrhage volume and outcome after ICH. METHODS We examined the autonomic modulation using frequency domain analysis of HRV during the acute phase of the ICH and in a healthy age- and hypertension-matched control group. Hematoma volume, intraventricular extension, initial stroke severity and baseline demographic, clinical parameters as well as mortality and functional outcome were included in the analysis. RESULTS 47 patients with ICH and 47 age- and hypertension matched controls were analyzed. ICH patients showed significantly lower total high frequency band (HF) and low frequency band (LF) powers (p = 0.01, p < 0.001), higher normalized HF power (p = 0.03), and lower LF/HF ratio (p < 0.001) as compared to the controls. Autonomic parameters showed associations with stroke severity (p = 0.004) and intraventricular involvement (p = 0.01) and predicted poor outcome independently (p = 0.02). CONCLUSIONS Autonomic changes seems to be present in acute ICH and are associated with poor outcome independently. This may have future monitoring and therapeutic implications.
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Affiliation(s)
- Jozef Szabo
- First Dept. of Neurology, University Hospital Bratislava, Comenius University Bratislava, Slovakia
| | - Peter Smielewski
- Div. of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Marek Czosnyka
- Div. of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | | | - Stefan Krebs
- Dept. of Neurology, St. John's Hospital Vienna, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Pavel Siarnik
- First Dept. of Neurology, University Hospital Bratislava, Comenius University Bratislava, Slovakia
| | - Marek Sykora
- Dept. of Neurology, St. John's Hospital Vienna, Medical Faculty, Sigmund Freud University, Vienna, Austria; Dept. of Neurology, University of Heidelberg, Heidelberg, Germany.
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22
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Bento L, Fonseca-Pinto R, Póvoa P. Autonomic nervous system monitoring in intensive care as a prognostic tool. Systematic review. Rev Bras Ter Intensiva 2018; 29:481-489. [PMID: 29340538 PMCID: PMC5764561 DOI: 10.5935/0103-507x.20170072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/18/2017] [Indexed: 01/13/2023] Open
Abstract
Objective To present a systematic review of the use of autonomic nervous system
monitoring as a prognostic tool in intensive care units by assessing heart
rate variability. Methods Literature review of studies published until July 2016 listed in
PubMed/Medline and conducted in intensive care units, on autonomic nervous
system monitoring, via analysis of heart rate variability as a prognostic
tool (mortality study). The following English terms were entered in the
search field: ("autonomic nervous system" OR "heart rate variability") AND
("intensive care" OR "critical care" OR "emergency care" OR "ICU") AND
("prognosis" OR "prognoses" OR "mortality"). Results There was an increased likelihood of death in patients who had a decrease in
heart rate variability as analyzed via heart rate variance, cardiac
uncoupling, heart rate volatility, integer heart rate variability, standard
deviation of NN intervals, root mean square of successive differences, total
power, low frequency, very low frequency, low frequency/high frequency
ratio, ratio of short-term to long-term fractal exponents, Shannon entropy,
multiscale entropy and approximate entropy. Conclusion In patients admitted to intensive care units, regardless of the pathology,
heart rate variability varies inversely with clinical severity and
prognosis.
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Affiliation(s)
- Luis Bento
- Unidade de Urgência Médica, Centro Hospitalar de Lisboa Central, EPE - Lisboa, Portugal
| | - Rui Fonseca-Pinto
- Instituto Politécnico de Leiria - Leiria, Portugal.,Instituto de Telecomunicações, MSP - Leiria, Portugal
| | - Pedro Póvoa
- Unidade de Cuidados Intensivos Polivalente, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal.,NOVA Medical School, CEDOC, Universidade Nova de Lisboa - Lisboa, Portugal
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23
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Deepika A, Devi BI, Shukla D, Sathyaprabha TN, Christopher R, Ramesh SS. Neuroimmunology of Traumatic Brain Injury: A Longitudinal Study of Interdependency of Inflammatory Markers and Heart Rate Variability in Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:1124-1131. [DOI: 10.1089/neu.2017.5151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Akhil Deepika
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Talakad N. Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
| | - Shruthi S. Ramesh
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences [NIMHANS], Bangalore, India
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24
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Bishop SA, Dech RT, Guzik P, Neary JP. Heart rate variability and implication for sport concussion. Clin Physiol Funct Imaging 2017; 38:733-742. [PMID: 29144026 DOI: 10.1111/cpf.12487] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 10/19/2017] [Indexed: 12/12/2022]
Abstract
Finding sensitive and specific markers for sports-related concussion is both challenging and clinically important. Such biomarkers might be helpful in the management of patients with concussion (i.e. diagnosis, monitoring and risk prediction). Among many parameters, blood flow-pressure metrics and heart rate variability (HRV) have been used to gauge concussion outcomes. Reports on the relation between HRV and both acute and prolonged concussion recovery are conflicting. While some authors report on differences in the low-frequency (LF) component of HRV during postural manipulations and postexercise conditions, others observe no significant differences in various HRV measures. Despite the early success of using the HRV LF for concussion recovery, the interpretation of the LF is debated. Recent research suggests the LF power is a net effect of several intrinsic modulatory factors from both sympathetic and parasympathetic branches of the autonomic nervous system, vagally mediated baroreflex and even some respiratory influences at lower respiratory rate. There are only a few well-controlled concussion studies that specifically examine the contribution of the autonomic nervous system branches with HRV for concussion management. This study reviews the most recent HRV- concussion literature and the underlying HRV physiology. It also highlights cerebral blood flow studies related to concussion and the importance of multimodal assessment of various biological signals. It is hoped that a better understanding of the physiology behind HRV might generate cost-effective, repeatable and reliable protocols, all of which will improve the interpretation of HRV throughout concussion recovery.
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Affiliation(s)
- Scott A Bishop
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Ryan T Dech
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Przemyslaw Guzik
- Department of Cardiology-Intensive Care Therapy & Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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25
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Hilz MJ, Wang R, Markus J, Ammon F, Hösl KM, Flanagan SR, Winder K, Koehn J. Severity of traumatic brain injury correlates with long-term cardiovascular autonomic dysfunction. J Neurol 2017; 264:1956-1967. [PMID: 28770375 PMCID: PMC5587629 DOI: 10.1007/s00415-017-8581-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/21/2017] [Accepted: 07/25/2017] [Indexed: 01/22/2023]
Abstract
After traumatic brain injury (TBI), central autonomic dysfunction might contribute to long-term increased mortality rates. Central autonomic dysfunction might depend on initial trauma severity. This study was performed to evaluate differences in autonomic modulation at rest and upon standing between patients with a history of mild TBI (post-mild-TBI patients), moderate or severe TBI (post-moderate–severe-TBI patients), and healthy controls. In 20 post-mild-TBI patients (6–78 months after TBI), age-matched 20 post-moderate–severe-TBI patients (6–94 months after TBI) and 20 controls, we monitored respiration, RR intervals (RRI) and systolic blood pressure (BPsys) at supine rest and upon standing. We determined mainly sympathetic low (LF) and parasympathetic high (HF) frequency powers of RRI fluctuations, sympathetically mediated LF-BPsys powers, LF/HF-RRI ratios, normalized (nu) LF-RRI and HF-RRI powers, and compared data between groups, at rest and upon standing (ANOVA with post hoc testing). We correlated autonomic parameters with initial Glasgow Coma Scale (GCS) scores (Spearman test; significance: p < 0.05). Supine BPsys and LFnu-RRI powers were higher while HFnu-RRI powers were lower in post-moderate–severe-TBI patients than post-mild-TBI patients and controls. LFnu-RRI powers were higher and HFnu-RRI powers were lower in post-mild-TBI patients than controls. Upon standing, only post-mild-TBI patients and controls increased LF-BPsys powers and BPsys and decreased HF-RRI powers. GCS scores correlated positively with LFnu-RRI powers, LF/HF-RRI ratios, and inversely with HFnu-RRI powers, at standing position. More than 6 months after TBI, there is autonomic dysfunction at rest and upon standing which is more pronounced after moderate–severe than mild TBI and in part correlates with initial trauma severity.
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Affiliation(s)
- Max J Hilz
- Clinical Department of Autonomic Neurology, University College London, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. .,Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany. .,Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, NY, USA.
| | - Ruihao Wang
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jörg Markus
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Fabian Ammon
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Steven R Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Klemens Winder
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Julia Koehn
- Department of Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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26
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Bishop SA, Neary JP. Assessing prefrontal cortex oxygenation after sport concussion with near-infrared spectroscopy. Clin Physiol Funct Imaging 2017. [DOI: 10.1111/cpf.12447] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Scott A. Bishop
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
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27
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Autonomic Impairment in Severe Traumatic Brain Injury: A Multimodal Neuromonitoring Study. Crit Care Med 2017; 44:1173-81. [PMID: 26968025 DOI: 10.1097/ccm.0000000000001624] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Autonomic impairment after acute traumatic brain injury has been associated independently with both increased morbidity and mortality. Links between autonomic impairment and increased intracranial pressure or impaired cerebral autoregulation have been described as well. However, relationships between autonomic impairment, intracranial pressure, impaired cerebral autoregulation, and outcome remain poorly explored. Using continuous measurements of heart rate variability and baroreflex sensitivity we aimed to test whether autonomic markers are associated with functional outcome and mortality independently of intracranial variables. Further, we aimed to evaluate the relationships between autonomic functions, intracranial pressure, and cerebral autoregulation. DESIGN Retrospective analysis of a prospective database. SETTING Neurocritical care unit in a university hospital. SUBJECTS Sedated patients with severe traumatic brain injury. MEASUREMENTS AND MAIN RESULTS Waveforms of intracranial pressure and arterial blood pressure, baseline Glasgow Coma Scale and 6 months Glasgow Outcome Scale were recorded. Baroreflex sensitivity was assessed every 10 seconds using a modified cross-correlational method. Frequency domain analyses of heart rate variability were performed automatically every 10 seconds from a moving 300 seconds of the monitoring time window. Mean values of baroreflex sensitivity, heart rate variability, intracranial pressure, arterial blood pressure, cerebral perfusion pressure, and impaired cerebral autoregulation over the entire monitoring period were calculated for each patient. Two hundred and sixty-two patients with a median age of 36 years entered the analysis. The median admission Glasgow Coma Scale was 6, the median Glasgow Outcome Scale was 3, and the mortality at 6 months was 23%. Baroreflex sensitivity (adjusted odds ratio, 0.9; p = 0.02) and relative power of a high frequency band of heart rate variability (adjusted odds ratio, 1.05; p < 0.001) were individually associated with mortality, independently of age, admission Glasgow Coma Scale, intracranial pressure, pressure reactivity index, or cerebral perfusion pressure. Baroreflex sensitivity showed no correlation with intracranial pressure or cerebral perfusion pressure; the correlation with pressure reactivity index was strong in older patients (age, > 60 yr). The relative power of high frequency correlated significantly with intracranial pressure and cerebral perfusion pressure, but not with pressure reactivity index. The relative power of low frequency correlated significantly with pressure reactivity index. CONCLUSIONS Autonomic impairment, as measured by heart rate variability and baroreflex sensitivity, is significantly associated with increased mortality after traumatic brain injury. These effects, though partially interlinked, seem to be independent of age, trauma severity, intracranial pressure, or autoregulatory status, and thus represent a discrete phenomenon in the pathophysiology of traumatic brain injury. Continuous measurements of heart rate variability and baroreflex sensitivity in the neuromonitoring setting of severe traumatic brain injury may carry novel pathophysiological and predictive information.
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28
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Gao L, Smielewski P, Czosnyka M, Ercole A. Early Asymmetric Cardio-Cerebral Causality and Outcome after Severe Traumatic Brain Injury. J Neurotrauma 2017; 34:2743-2752. [PMID: 28330412 DOI: 10.1089/neu.2016.4787] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The brain and heart are two vital systems in health and disease, increasingly recognized as a complex, interdependent network with constant information flow in both directions. After severe traumatic brain injury (TBI), the causal, directed interactions between the brain, heart, and autonomic nervous system have not been well established. Novel methods are needed to probe unmeasured, potentially prognostic information in complex biological networks that are not revealed by traditional means. In this study, we examined potential bidirectional causality between intracranial pressure (ICP), mean arterial pressure (MAP), and heart rate (HR) and its relationship to mortality in a 24-h period early post-TBI. We applied Granger causality (GC) analysis to cardio-cerebral monitoring data from 171 severe TBI patients admitted to a single neurocritical care center over a 10-year period. There was significant bidirectional causality between ICP and MAP, MAP and HR, and ICP and HR in the majority of patients (p < 0.01). MAP influenced both ICP and HR to a greater extent (higher GC, p < 0. 00001), but there was no dominant unidirectional causality between ICP and HR (p = 0.85). Those who died had significantly lower GC for ICP causing MAP and HR causing ICP (p = 0.006 and p = 0.004, respectively) and were predictors of mortality independent of age, sex, and traditional intracranial variables (ICP, cerebral perfusion pressure, GCS, and pressure reactivity index). Examining the brain and heart with GC-based features for the first time in severe TBI patients has confirmed strong interdependence and reveals a significant relationship between select causality pairs and mortality. These results support the notion that impaired causal information flow between the cerebrovascular, autonomic, and cardiovascular systems are of central importance in severe TBI.
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Affiliation(s)
- Lei Gao
- 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital , Boston, Massachusetts
| | - Peter Smielewski
- 2 Division of Neurosurgery, University of Cambridge , Cambridge, United Kingdom
| | - Marek Czosnyka
- 2 Division of Neurosurgery, University of Cambridge , Cambridge, United Kingdom
| | - Ari Ercole
- 3 Department of Anesthesia, University of Cambridge , Cambridge, United Kingdom
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29
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Dobson JL, Yarbrough MB, Perez J, Evans K, Buckley T. Sport-related concussion induces transient cardiovascular autonomic dysfunction. Am J Physiol Regul Integr Comp Physiol 2017; 312:R575-R584. [DOI: 10.1152/ajpregu.00499.2016] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
Recent evidence suggests that concussions may disrupt autonomic cardiovascular control. This study investigated the initial effects of concussion on cardiovascular function using three autonomic reflex tests. Twenty-three recreational athletes (12 women, 11 men) were divided into concussed ( n = 12) and control ( n = 11) groups. Concussed participants performed forced breathing, standing, and Valsalva autonomic tests four times: 1) within 48 h of injury; 2) 24 h later; 3) 1 wk after injury; and 4) 2 wk after injury. The controls performed the same tests on the same schedule. Differences in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to the tests were continuously measured using finger photoplethysmography and were analyzed using repeated-measures multivariate ANOVAs and ANOVAs. Within 48 h of injury, the concussed group had significantly greater resting SBP ( t21= 2.44, P = 0.02, d = 1.03), HR ( t21= 2.33, P = 0.03, d = 1.01), and SBP responses to standing ( t21= 2.98, P = 0.01, d = 1.24), and 90% SBP normalization times ( t21= 2.64, P = 0.02, d = 1.10) after the Valsalva, but those group differences subsided 24 h later. There was also a significant interaction with the HR responses to forced breathing ( F3,60= 4.13, P = 0.01, ηp2= 0.17), indicating the concussed responses declined relative to the control’s over time. The results demonstrate that concussion disrupted autonomic cardiovascular control, and that autonomic reflex tests are practical means by which to evaluate that dysfunction.
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Affiliation(s)
- John L. Dobson
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Mary Beth Yarbrough
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Jose Perez
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Kelsey Evans
- School of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Thomas Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware; and
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware
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30
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Respiratory induced heart rate variability during slow mechanical ventilation : Marker to exclude brain death patients. Wien Klin Wochenschr 2017; 129:251-258. [PMID: 28236042 DOI: 10.1007/s00508-017-1176-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Respiratory induced heart rate variability (rHRV) was analysed in mechanically ventilated patients during two levels of sedation and brain death. Our aim was to determine whether rHRV can distinguish between different levels of sedation and especially between brain death and sedated patients. METHODS In this study 30 critically ill and 23 brain death patients were included and four respiratory rates of 15, 12, 8 and 6 breaths per minute, each lasting 5 min were used. Two sedation levels, basal and deep, were performed in the critically ill patients. Heart rate and blood pressure changes induced by ventilation were subsequently detected and analysed. RESULTS Significant differences were found in rHRV and rHRV adjusted for tidal volume (rHRV/VT) between critically ill and brain death patients during slow breathing at 6 or 8 breaths per minute. The rHRV at 6 breaths per minute was below 15 ms in all brain death subjects except one. The rHRV/VT was lower than 25 ms/l at both 6 and 8 breaths per minute in all brain death patients and simultaneously at 75% of non-brain death patients was higher (specificity 1, sensitivity 0.24). Differences in rHRV and rHRV/VTs between basal and deep sedation were not significant. CONCLUSIONS The main clinical benefit of the study is the finding that rHRV and rHRV/VT during 6 and 8 breaths per minute can differentiate between critically ill and brain death patients. An rHRV/VT exceeding 25 ms/l reliably excludes brain death.
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31
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Bishop S, Dech R, Baker T, Butz M, Aravinthan K, Neary JP. Parasympathetic baroreflexes and heart rate variability during acute stage of sport concussion recovery. Brain Inj 2017; 31:247-259. [DOI: 10.1080/02699052.2016.1226385] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Scott Bishop
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Ryan Dech
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Taylor Baker
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Matthew Butz
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kaishan Aravinthan
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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32
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van den Brule JMD, Vinke EJ, van Loon LM, van der Hoeven JG, Hoedemaekers CWE. Low spontaneous variability in cerebral blood flow velocity in non-survivors after cardiac arrest. Resuscitation 2016; 111:110-115. [PMID: 28007503 DOI: 10.1016/j.resuscitation.2016.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/05/2016] [Accepted: 12/12/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate spontaneous variability in the time and frequency domain in mean flow velocity (MFV) and mean arterial pressure (MAP) in comatose patients after cardiac arrest, and determine possible differences between survivors and non-survivors. METHODS A prospective observational study was performed at the ICU of a tertiary care university hospital in the Netherlands. We studied 11 comatose patients and 10 controls. MFV in the middle cerebral artery was measured with simultaneously recording of MAP. Coefficient of variation (CV) was used as a standardized measure of dispersion in the time domain. In the frequency domain, the average spectral power of MAP and MFV were calculated in the very low, low and high frequency bands. RESULTS In survivors CV of MFV increased from 4.66 [3.92-6.28] to 7.52 [5.52-15.23] % at T=72h. In non-survivors CV of MFV decreased from 9.02 [1.70-9.36] to 1.97 [1.97-1.97] %. CV of MAP was low immediately after admission (1.46 [1.09-2.25] %) and remained low at 72h (3.05 [1.87-3.63] %) (p=0.13). There were no differences in CV of MAP between survivors and non-survivors (p=0.30). We noticed significant differences between survivors and non-survivors in the VLF band for average spectral power of MAP (p=0.03) and MFV (p=0.003), whereby the power of both MAP and MFV increased in survivors during admission, while remaining low in non-survivors. CONCLUSIONS Cerebral blood flow is altered after cardiac arrest, with decreased spontaneous fluctuations in non-survivors. Most likely, these changes are the consequence of impaired intrinsic myogenic vascular function and autonomic dysregulation.
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Affiliation(s)
- J M D van den Brule
- Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - E J Vinke
- Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L M van Loon
- Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J G van der Hoeven
- Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C W E Hoedemaekers
- Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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33
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Specific Differential Entropy Rate Estimation for Continuous-Valued Time Series. ENTROPY 2016. [DOI: 10.3390/e18050190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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Gao L, Smielewski P, Czosnyka M, Ercole A. Cerebrovascular Signal Complexity Six Hours after Intensive Care Unit Admission Correlates with Outcome after Severe Traumatic Brain Injury. J Neurotrauma 2016; 33:2011-2018. [PMID: 26916703 DOI: 10.1089/neu.2015.4228] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Disease states are associated with a breakdown in healthy interactions and are often characterized by reduced signal complexity. We applied approximate entropy (ApEn) analysis to investigate the correlation between the complexity of heart rate (ApEn-HR), mean arterial pressure (ApEn-MAP), intracranial pressure (ApEn-ICP), and a combined ApEn-product (product of the three individual ApEns) and outcome after traumatic brain injury. In 174 severe traumatic brain injured patients, we found significant differences across groups classified by the Glasgow Outcome Score in ApEn-HR (p = 0.007), ApEn-MAP (p = 0.02), ApEn-ICP (p = 0.01), ApEn-product (p = 0.001), and pressure reactivity index (PRx) (p = 0.004) in the first 6 h. This relationship strengthened in a 24 h and 72 h analysis (ApEn-MAP continued to correlate with death but was not correlated with favorable outcome). Outcome was dichotomized as survival versus death, and favorable versus unfavorable; the ApEn-product achieved the strongest statistical significance at 6 h (F = 11.0; p = 0.001 and F = 10.5; p = 0.001, respectively) and was a significant independent predictor of mortality and favorable outcome (p < 0.001). Patients in the lowest quartile for ApEn-product were over four times more likely to die (39.5% vs. 9.3%, p < 0.001) than those in the highest quartile. ApEn-ICP was inversely correlated with PRx (r = -0.39, p < 0.000001) indicating unique information related to impaired cerebral autoregulation. Our results demonstrate that as early as 6 h into monitoring, complexity measures from easily attainable vital signs, such as HR and MAP, in addition to ICP, can help triage those who require more intensive neurological management at an early stage.
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Affiliation(s)
- Lei Gao
- 1 Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital , Boston, Massachusetts
| | - Peter Smielewski
- 2 Division of Neurosurgery, Department of Anesthesia University of Cambridge , Cambridge, United Kingdom
| | - Marek Czosnyka
- 2 Division of Neurosurgery, Department of Anesthesia University of Cambridge , Cambridge, United Kingdom
| | - Ari Ercole
- 3 Neurosciences Critical Care Unit, Department of Anesthesia University of Cambridge , Cambridge, United Kingdom
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Riganello F, Cortese MD, Arcuri F, Quintieri M, Dolce G. How Can Music Influence the Autonomic Nervous System Response in Patients with Severe Disorder of Consciousness? Front Neurosci 2015; 9:461. [PMID: 26696818 PMCID: PMC4674557 DOI: 10.3389/fnins.2015.00461] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/20/2015] [Indexed: 11/13/2022] Open
Abstract
Activations to pleasant and unpleasant musical stimuli were observed within an extensive neuronal network and different brain structures, as well as in the processing of the syntactic and semantic aspects of the music. Previous studies evidenced a correlation between autonomic activity and emotion evoked by music listening in patients with Disorders of Consciousness (DoC). In this study, we analyzed retrospectively the autonomic response to musical stimuli by mean of normalized units of Low Frequency (nuLF) and Sample Entropy (SampEn) of Heart Rate Variability (HRV) parameters, and their possible correlation to the different complexity of four musical samples (i.e., Mussorgsky, Tchaikovsky, Grieg, and Boccherini) in Healthy subjects and Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients. The complexity of musical sample was based on Formal Complexity and General Dynamics parameters defined by Imberty's semiology studies. The results showed a significant difference between the two groups for SampEn during the listening of Mussorgsky's music and for nuLF during the listening of Boccherini and Mussorgsky's music. Moreover, the VS/UWS group showed a reduction of nuLF as well as SampEn comparing music of increasing Formal Complexity and General Dynamics. These results put in evidence how the internal structure of the music can change the autonomic response in patients with DoC. Further investigations are required to better comprehend how musical stimulation can modify the autonomic response in DoC patients, in order to administer the stimuli in a more effective way.
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Affiliation(s)
| | - Maria D Cortese
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Francesco Arcuri
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Maria Quintieri
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
| | - Giuliano Dolce
- Research in Advanced Neurorehabilitation, Istituto S. Anna Crotone, Italy
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Abaji JP, Curnier D, Moore RD, Ellemberg D. Persisting Effects of Concussion on Heart Rate Variability during Physical Exertion. J Neurotrauma 2015; 33:811-7. [PMID: 26159461 DOI: 10.1089/neu.2015.3989] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to evaluate cardiac autonomic modulation in university athletes during the post-acute to late phase (mean, 95 days ±63) of injury at rest and during physical exertion. We also sought to evaluate the effect of time since injury and number of injuries on heart rate variability (HRV). We hypothesized that physical exertion would reveal persisting modifications in HRV following a concussion. We included, in a cross-sectional design, athletes who sustained a concussion and matched controls. Concussions were identified by a medical doctor using established criteria. Twelve male concussed and 12 control athletes took part in the study. Control participants were teammates who were chosen to match the concussed athletes with regard to their height, weight, education, and age. The beat-to-beat electrocardiogram intervals of the participants were measured at rest and during physical exertion (isometric hand grip contraction; IHGC), which was sustained for 3 minutes at 30% of the participants' maximum. Linear and nonlinear parameters of HRV were calculated. The ratio between low and high frequency (LF/HF) bands was calculated to assess the sympathovagal balance. During the IHGC, but not at rest, concussed athletes presented significantly lower power in HF bands, leading to a significantly higher LF/HF ratio (p ≤ 0.05). Thus, asymptomatic athletes still may exhibit modifications in cardiac autonomic modulation weeks to months following injury. These modifications may only become apparent during physical exertion. Monitoring HRV may aid diagnosis and provide insight about safe return to play.
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Affiliation(s)
| | - Daniel Curnier
- 1 Department of Kinesiology, Université de Montréal , Montreal, Quebec, Canada .,2 Research Center, CHU Sainte-Justine, Université de Montréal , Montreal, Quebec, Canada
| | - Robert Davis Moore
- 1 Department of Kinesiology, Université de Montréal , Montreal, Quebec, Canada
| | - Dave Ellemberg
- 1 Department of Kinesiology, Université de Montréal , Montreal, Quebec, Canada .,2 Research Center, CHU Sainte-Justine, Université de Montréal , Montreal, Quebec, Canada
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Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome. Pediatr Res 2015; 77:681-7. [PMID: 25665054 DOI: 10.1038/pr.2015.28] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/04/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The study aims to describe heart rate variability (HRV) in neonatal hypoxic ischemic encephalopathy (HIE) and correlate HRV with electroencephalographic (EEG) grade of HIE and neurodevelopmental outcome. METHODS Multichannel EEG and electrocardiography (ECG) were assessed at 12-48 h after birth in healthy and encephalopathic full-term neonates. EEGs were graded (normal, mild, moderate, and severe). Neurodevelopmental outcome was assessed at 2 y of age. Seven HRV features were calculated using normalized-RR (NN) interval. The correlation of these features with EEG grade and outcome were measured using Spearman's correlation coefficient. RESULTS HRV was significantly associated with HIE severity (P < 0.05): standard deviation of NN interval (SDNN) (r = -0.62), triangular interpolation of NN interval histogram (TINN) (r = -0.65), mean NN interval (r = -0.48), and the very low frequency (VLF) (r = -0.60), low frequency (LF) (r = -0.67) and high frequency (HF) components of the NN interval (r = -0.60). SDNN at 24 and 48 h were significantly associated (P < 0.05) with neurodevelopmental outcome (r = -0.41 and -0.54, respectively). CONCLUSION HRV is associated with EEG grade of HIE and neurodevelopmental outcome. HRV has potential as a prognostic tool to complement EEG.
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Straube A, Klein M, Erbguth F, Maschke M, Klawe C, Sander D, Hilz MJ, Ziemssen T, Klucken J, Kohl Z, Winkler J, Bettendorf M, Staykov D, Berrouschot J, Dörfler A. Metabolische Störungen. NEUROINTENSIV 2015. [PMCID: PMC7175475 DOI: 10.1007/978-3-662-46500-4_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Im folgenden Kapitel werden die verschiedenen metabolischen Störungen betrachtet. Zunächst wird auf die allgemeinen und spezifischen neurologischen Komplikationen bei Organtransplantation eingegangen. Dann geht es um die metabolischen Enzephalopathien: Störungen der Gehirntätigkeit bei angeborenen und erworbenen Stoffwechselerkrankungen im engeren Sinn, Elektrolytstörungen, Hypovitaminosen, zerebrale Folgen einzelner Organdysfunktionen, zerebrale Hypoxien, Endotheliopathien und Mitochondropathien. Anschließend werden das Alkoholdelir und die Wernicke-Enzephalopathie erörtert. Bei zahlreichen akuten Erkrankungen von Gehirn, Rückenmark und peripherem Nervensystem treten typische Störungen vegetativer Systeme auf, deren Erkennung und Therapie insbesondere bei Intensivpatienten eine vitale Bedeutung haben kann: die autonomen Störungen. Bei der zentralen pontinen Myelinolyse kommt es zu einer akuten, vorwiegend fokal-symmetrischen Demyelinisierung im Hirnparenchym. Auch Basalganglienerkrankungen können intensivmedizinisch relevant werden. Und schließlich wird die akute Stressreaktion betrachtet, die aufgrund der vielfältigen metabolischen und endokrinen Veränderungen bei kritischen Erkrankungen entsteht. Gerade das RCVS als neuere Krankheitsentität und wichtige Differenzialdiagnose zur Vaskulitis des ZNS verdient einen eigenen Platz, in diesem Unterkapitel werden ebenfalls verwandte Syndrome wie die hypertensive Enzephalopathie und das PRES abgehandelt.
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Abstract
PURPOSE OF REVIEW New developments in mechanical ventilation have focused on increasing the patient's control of the ventilator by implementing information on lung mechanics and respiratory drive. Effort-adapted modes of assisted breathing are presented and their potential advantages are discussed. RECENT FINDINGS Adaptive support ventilation, proportional assist ventilation with load adjustable gain factors and neurally adjusted ventilatory assist are ventilatory modes that follow the concept of adapting the assist to a defined target, instantaneous changes in respiratory drive or lung mechanics. Improved patient ventilator interaction, sufficient unloading of the respiratory muscles and increased comfort have been recently associated with these ventilator modalities. There are, however, scarce data with regard to outcome improvement, such as length of mechanical ventilation, ICU stay or mortality (commonly accepted targets to demonstrate clinical superiority). SUMMARY Within recent years, a major step forward in the evolution of assisted (effort-adapted) modes of mechanical ventilation was accomplished. There is growing evidence that supports the physiological concept of closed-loop effort-adapted assisted modes of mechanical ventilation. However, at present, the translation into a clear outcome benefit remains to be proven. In order to fill the knowledge gap that impedes the broader application, larger randomized controlled trials are urgently needed. However, with clearly proven drawbacks of conventional assisted modes such as pressure support ventilation, it is probably about time to leave these modes introduced decades ago behind.
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Kox M, Vrouwenvelder MQ, Pompe JC, van der Hoeven JG, Pickkers P, Hoedemaekers CW. The effects of brain injury on heart rate variability and the innate immune response in critically ill patients. J Neurotrauma 2012; 29:747-55. [PMID: 22111862 DOI: 10.1089/neu.2011.2035] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Brain injury and its related increased intracranial pressure (ICP) may lead to increased vagus nerve activity and the subsequent suppression of innate immunity via the cholinergic anti-inflammatory pathway. This may explain the observed increased susceptibility to infection in these patients. In the present study, we investigated the association between brain injury, vagus nerve activity, and innate immunity. We determined heart rate variability (HRV) as a measure of vagus nerve activity, plasma cytokines, and cytokine production of ex vivo lipopolysaccharide-stimulated whole blood in the first 4 days of admission to the neurological intensive care unit (ICU) in 34 patients with various forms of brain damage. HRV, immune parameters, and the correlations between these measures were analyzed in the entire group of patients and in subgroups of patients with conditions associated with high (intracranial hemorrhage [ICH]) and normal ICP (subarachnoid hemorrhage [SAH] with an extraventricular drain alleviating ICP). Healthy volunteers were used for comparison. HRV total spectral power and ex vivo-stimulated cytokine production were severely depressed in patients compared with healthy volunteers (p<0.05). Furthermore, HRV analysis showed that normalized units of high-frequency power (HFnu, corresponding with vagus nerve activity) was higher, and the low-frequency:high-frequency ratio (LF:HF, corresponding with sympathovagal balance) was lower in patients compared to healthy volunteers (p<0.05). HFnu correlated inversely with ex vivo-stimulated tumor necrosis factor-α (TNF-α) production (r=-0.22, p=0.025). The most pronounced suppression of ex vivo-stimulated cytokine production was observed in the ICH group. Furthermore, in ICH patients, HFnu correlated strongly with lower plasma TNF-α levels (r=-0.73, p=0.002). Our data suggest that brain injury, and especially conditions associated with increased ICP, is associated with vagus nerve-mediated immune suppression.
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Affiliation(s)
- Matthijs Kox
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, The Netherlands.
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Singer M, Matthay MA. Clinical review: Thinking outside the box--an iconoclastic view of current practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:225. [PMID: 21888690 PMCID: PMC3387582 DOI: 10.1186/cc10245] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Many advances in medicine have been achieved through challenging established dogma with revolutionary thought and novel practices. Each and every specialty is reinvigorated by regular re-evaluation of processes and practices in the light of new evidence and fresh conceptualization. Challenge can galvanize fresh thinking and new approaches, yet may also reinforce and strengthen traditional paradigms if the prevailing orthodoxy is subsequently revalidated. This article is a synopsis of a roundtable meeting held in Brussels in March 2010 designed specifically to confront doctrine with reasoned scientific argument, and to propose new ideas for advancing critical care practices and outcomes.
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Affiliation(s)
- Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Department of Medicine, University College London, London WC1E 6BT, UK.
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Clinical applications of heart rate variability in the triage and assessment of traumatically injured patients. Anesthesiol Res Pract 2011; 2011:416590. [PMID: 21350685 PMCID: PMC3038414 DOI: 10.1155/2011/416590] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 01/12/2011] [Indexed: 11/18/2022] Open
Abstract
Heart rate variability (HRV) is a method of physiologic assessment which uses fluctuations in the RR intervals to evaluate modulation of the heart rate by the autonomic nervous system (ANS). Decreased variability has been studied as a marker of increased pathology and a predictor of morbidity and mortality in multiple medical disciplines. HRV is potentially useful in trauma as a tool for prehospital triage, initial patient assessment, and continuous monitoring of critically injured patients. However, several technical limitations and a lack of standardized values have inhibited its clinical implementation in trauma. The purpose of this paper is to describe the three analytical methods (time domain, frequency domain, and entropy) and specific clinical populations that have been evaluated in trauma patients and to identify key issues regarding HRV that must be explored if it is to be widely adopted for the assessment of trauma patients.
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Kasaoka S, Nakahara T, Kawamura Y, Tsuruta R, Maekawa T. Real-time monitoring of heart rate variability in critically ill patients. J Crit Care 2009; 25:313-6. [PMID: 19781905 DOI: 10.1016/j.jcrc.2009.06.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 05/28/2009] [Accepted: 06/21/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE Heart rate variability (HRV) is widely used to evaluate autonomic nervous function; however, real-time monitoring of HRV has rarely been attempted in the intensive care unit (ICU). We report our experience in performing real-time monitoring of HRV in our ICU. METHODS We investigated 10 critically ill patients on total ventilatory support. Heart rate variability analysis was performed using the MemCalc system, which is a noninvasive, real-time analysis system. The low-frequency (LF) component of HRV reflects sympathetic and parasympathetic modulation, whereas the high-frequency (HF) component mainly reflects parasympathetic modulation. The LF/HF ratio represents a measure of sympathetic/parasympathetic balance. RESULTS The HRV parameters for patients breathing spontaneously after extubation were significantly higher than those for patients on total ventilatory support. These findings suggest that mechanical ventilation under sedation may reduce autonomic nervous function in critically ill patients. In a representative case with septic shock, systolic blood pressure and LF/HF ratio showed a significant increase after intravenous infusion of epinephrine and then the HF component showed a significant increase due to vagal reflex. CONCLUSIONS The MemCalc system is practicable for real-time monitoring of HRV in the ICU. Heart rate variability parameters may offer useful information in the management of critically ill patients.
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Affiliation(s)
- Shunji Kasaoka
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan.
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Transient suppression of heart rate complexity in concussed athletes. Auton Neurosci 2009; 148:101-3. [PMID: 19303821 DOI: 10.1016/j.autneu.2009.03.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 03/03/2009] [Accepted: 03/04/2009] [Indexed: 11/20/2022]
Abstract
Heart rate variability (HRV) and complexity (HRC) were calculated at rest and during an isometric hand grip test (IHGT) within 48-hours (48 h) and two weeks (Week Two) of a concussion in athletes (CG) and control subjects. No differences were present at rest or in HRV during IGHT. HRC was significantly lower in the CG compared to controls at 48 h during IHGT. In CG at Week Two during IHGT, HRC was significantly greater than 48 h observations and not significantly different than controls. The findings suggest that HRC may have utility in detecting efferent cardiac autonomic anomalies within two weeks of concussion.
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