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Jhen RN, Wang PC, Chang YM, Kao JL, Wu ECH, Shiao CC. The Clinical Significance and Application of Heart Rate Variability in Dialysis Patients: A Narrative Review. Biomedicines 2024; 12:1547. [PMID: 39062120 DOI: 10.3390/biomedicines12071547] [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: 05/27/2024] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Autonomic nervous system (ANS) dysfunction is prevalent in end-stage kidney disease (ESKD) patients, carrying significant risks for morbidity and mortality. Heart rate variability (HRV) is a simple and non-invasive method to evaluate ANS functions and predict prognoses in specific patient populations. Since there is a lack of a clear understanding of the clinical significance of HRV in predicting prognoses in ESKD patients, an updated review on this topic is urgently warranted. The clinical significance of HRV in dialysis patients includes its associations with metabolic syndrome, nutritional status, intradialytic hypotension, vascular access failure, major adverse cardiovascular events, and mortality. These findings underscore the essential role of the autonomic reserve, which might denote the elevation of ANS activity as a response to external stimulus. Patients with a higher level of sympathetic activity at the resting stage, but who are unable to adequately elevate their sympathetic activity under stress might be susceptible to a worse outcome in critical circumstances. Further applications of HRV include HRV biofeedback, risk classification, and real-time HRV monitoring. Overall, HRV is an optimal tool for predicting prognoses in dialysis patients. Further study is encouraged in order to gain a clearer understanding of the clinical significance and application of HRV, and thereby enhance the care of ESKD patients.
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Affiliation(s)
- Rong-Na Jhen
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 265, Taiwan
| | - Ping-Chen Wang
- Department of Medical Research and Education, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 265, Taiwan
| | - Yu-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 265, Taiwan
| | - Jsun-Liang Kao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 265, Taiwan
| | - Eric Chien-Hwa Wu
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Jiaoxi, No. 129, Sec. 4, Jiaoxi Rd., Jiaoxi Township, Yilan County 262, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, Yilan County 265, Taiwan
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Dumargne H, Patural H, Charbonnieras F, Charier D, Biscarrat C, Chivot M, Argaud L, Cour M, Dargent A. Exploration of COVID-19 associated bradycardia using heart rate variability analysis in a case-control study of ARDS patients. Heart Lung 2024; 68:74-80. [PMID: 38941770 DOI: 10.1016/j.hrtlng.2024.06.014] [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: 03/13/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Bradycardia and dysautonomia observed during SARS-Cov2 infection suggests involvement of the autonomic nervous system (ANS). Limited data exists on ANS dysregulation and its association with outcomes in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (C-ARDS) or other etiologies (NC-ARDS). OBJECTIVES We aimed to explore sympathovagal balance, assessed by heart rate variability (HRV), and its clinical prognostic value in C-ARDS compared with NC-ARDS. METHODS A single-center, prospective case-control study was conducted. Consecutive patients meeting ARDS criteria between 2020 and 2022 were included. HRV was assessed using 1-hour electrographic tracing during a stable, daytime period. RESULTS Twenty-four patients with C-ARDS and 19 with NC-ARDS were included. Age, sex and ARDS severity were similar between groups. The median heart rate was markedly lower in the C-ARDS group than in the NC-ARDS group (60 [53-72] versus 101 [91-112] bpm, p<.001). Most of HRV parameters were significantly increased in patients with C-ARDS. HRV correlated with heart rate only in patients with C-ARDS. A positive correlation was found between the low-to high-frequency ratio (LF/HF) and length of intensive care unit stay (r = 0.576, p<.001). CONCLUSION This study confirmed that C-ARDS was associated with marked bradycardia and severe ANS impairment, suggesting a sympathovagal imbalance with vagal overtone. Poor outcomes appeared to be more related to sympathetic rather than parasympathetic hyperactivation.
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Affiliation(s)
- Hugo Dumargne
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Hugues Patural
- Centre Hospitalier Universitaire de Saint Etienne, Service de réanimation pédiatrique, Saint-Etienne, France; INSERM, SAINBIOSE U1059, 42055 Saint-Etienne, France
| | - François Charbonnieras
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Cardiologie soins intensifs, 69004 Lyon, France
| | - David Charier
- INSERM, SAINBIOSE U1059, 42055 Saint-Etienne, France; Centre Hospitalier Universitaire de Saint Etienne, Service d'Anesthésie-Réanimation, Saint-Etienne, France
| | - Charlotte Biscarrat
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Matthieu Chivot
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Laurent Argaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Intensive-Réanimation, 69003 Lyon, France
| | - Auguste Dargent
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Anesthésie-Réanimation Médecine Intensive-Réanimation, 69495 Pierre-Bénite, Lyon, France; APCSe VetAgro Sup UPSP 2016.A101, 69280 Marcy l'Etoile, France.
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Ryan T, Walker AM, Liepert D. Discriminatory ability of perioperative heart rate variability in predicting postoperative complications in major urologic surgery: a prospective cohort study. Sci Rep 2024; 14:11965. [PMID: 38796614 PMCID: PMC11127941 DOI: 10.1038/s41598-024-62930-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/22/2024] [Indexed: 05/28/2024] Open
Abstract
We aimed to determine if continuous perioperative heart rate variability (HRV) monitoring could improve risk stratification compared to a short preoperative measurement in radical cystectomy patients. Electrocardiography (ECG) recordings were collected continuously preoperatively to discharge in 83 patients. Two, 5-min ECG signal segments (preoperative and at 24-h post ECG placement) were analyzed offline to extract HRV metrics. HRV metric discriminatory ability to identify patients with 30-day postoperative complications were analyzed using receiver operating characteristics curves. Sixty participants were included for analysis of which 27 (45%) developed a complication within 30 days postoperative. HRV was reduced in patients with complications. Postoperative standard deviation NN intervals and root mean square of successive differences had area under the curves (AUC) of 0.67 (95% CI 0.54 to 0.81) and 0.68 (95% CI 0.54 to 0.82), respectively. Significant discriminatory abilities were also reported for postoperative frequency metrics of absolute low frequency (LF) [AUC = 0.65 (95% CI 0.51 to 0.79)] and high frequency (HF) powers [AUC = 0.69 (95% CI 0.55 to 0.83)] and total power [AUC = 0.66 (95% CI 0.53 to 0.80)]. Postoperative acquired HRV metrics demonstrated improved discriminatory ability. Our findings suggest that longer-term perioperative HRV monitoring presents with superior ability to stratify complication risk.
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Affiliation(s)
- Talia Ryan
- Department of Anesthesiology, Perioperative and Pain Medicine Cumming School of Medicine, University of Calgary, Foothills Medical Center, 1403 29th St., Calgary, N.W., T2N 2T9, Canada.
| | - Andrew M Walker
- Department of Anesthesiology, Perioperative and Pain Medicine Cumming School of Medicine, University of Calgary, Foothills Medical Center, 1403 29th St., Calgary, N.W., T2N 2T9, Canada
| | - David Liepert
- Department of Anesthesiology, Perioperative and Pain Medicine Cumming School of Medicine, University of Calgary, Foothills Medical Center, 1403 29th St., Calgary, N.W., T2N 2T9, Canada
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Pendergrast TR, Chapin CA, Kriegermeier AA, Pardo AC, Bass LM, Sanchez-Pinto LN. Heart rate variability is associated with encephalopathy and outcomes in pediatric acute liver failure. Pediatr Res 2023; 93:1348-1353. [PMID: 35927573 DOI: 10.1038/s41390-022-02225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND More than half of children with pediatric acute liver failure (PALF) experience hepatic encephalopathy (HE), which is related to poor outcomes; however, HE is difficult to diagnose in children. The objective of this study was to evaluate if heart rate variability (HRV), a continuous measure of autonomic nervous system function, was related to the presence and severity of HE as well as clinical outcomes in children with PALF. METHODS We conducted a retrospective observational cohort study of 38 critically ill children with PALF to examine the association between HRV and HE severity and clinical outcome. HRV was estimated using the integer HRV (HRVi). Categorical variables were compared using the Fisher Exact test and continuous variables were compared using Kruskal-Wallis tests. Associations between grades of HE and minimum and median HRVi were evaluated with Pearson's correlation, with p values <0.05 considered significant. RESULTS A more negative median and minimum HRVi, indicating poorer autonomic nervous system function, was significantly associated with abnormal EEG findings, presence of HE, and poor outcomes (death or listing for transplant). CONCLUSIONS Heart rate variability may hold promise to predict outcomes in children with PALF, but these findings should be replicated in a larger sample. IMPACT The findings of our study suggest that heart rate variability is associated with clinical outcomes in children with acute liver failure, a cohort for which prognostics are challenging, especially in young children and infants. Use of heart rate variability in the clinical setting may facilitate earlier detection of children with pediatric acute liver failure (PALF) at high risk for severe hepatic encephalopathy and poor outcomes. Identification of children with PALF at high risk of decompensation may assist clinicians in making decisions about liver transplantation, an important, but resource-limited, treatment of PALF.
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Affiliation(s)
| | - Catherine A Chapin
- Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alyssa A Kriegermeier
- Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea C Pardo
- Neurology and Epilepsy, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lee M Bass
- Gastroenterology, Hepatology, and Nutrition, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L Nelson Sanchez-Pinto
- Critical Care and Preventive Medicine Health and Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Effect of the Sway Bed on Autonomic Response, Emotional Responses, and Muscle Stiffness in Children with Severe Motor and Intellectual Disabilities: A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10112337. [DOI: 10.3390/healthcare10112337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
Abstract
This cross-sectional study aimed to examine the effects of being swayed in a sway bed on children with severe motor and intellectual difficulties by examining potential differences in their autonomic and emotional responses, as well as their muscle hardness, and by comparing them with “a control condition without any stimulation”. Children’s heart rate variability, rectus femoris hardness, and passive hip abduction range of motion (ROM) were measured in two experimental conditions, differentiated by the presence of a 5-min sway stimulus. In each condition, the children’s faces were video-recorded and retrospectively rated subjectively by their homeroom teacher concerning the visible expression of eight emotions. Significant intervention-related effects were observed on the heart rate variability and the “Relax” item of the emotional response indicators but not on muscle hardness or hip ROM. Our findings provide evidence that using a motorized sway bed can promote relaxation in children with severe motor and intellectual disabilities by influencing their autonomic response.
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Endoh H, Kamimura N, Honda H, Nitta M. Early prognostication of neurological outcome by heart rate variability in adult patients with out-of-hospital sudden cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:323. [PMID: 31623658 PMCID: PMC6798365 DOI: 10.1186/s13054-019-2603-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 09/06/2019] [Indexed: 01/20/2023]
Abstract
Background Most deaths of comatose survivors of out-of-hospital sudden cardiac arrest result from withdrawal of life-sustaining treatment (WLST) decisions based on poor neurological prognostication and the family’s intention. Thus, accurate prognostication is crucial to avoid premature WLST decisions. However, targeted temperature management (TTM) with sedation or neuromuscular blockade against shivering significantly affects early prognostication. In this study, we investigated whether heart rate variability (HRV) analysis could prognosticate poor neurological outcome in comatose patients undergoing hypothermic TTM. Methods Between January 2015 and December 2017, adult patients with out-of-hospital sudden cardiac arrest, successfully resuscitated in the emergency department and admitted to the intensive care unit of the Niigata University in Japan, were prospectively included. All patients had an initial Glasgow Coma Scale motor score of 1 and received hypothermic TTM (at 34 °C). Twenty HRV-related variables (deceleration capacity; 4 time-, 3 geometric-, and 7 frequency-domain; and 5 complexity variables) were computed based on RR intervals between 0:00 and 8:00 am within 24 h after return of spontaneous circulation (ROSC). Based on Glasgow Outcome Scale (GOS) at 2 weeks after ROSC, patients were divided into good outcome (GOS 1–2) and poor outcome (GOS 3–5) groups. Results Seventy-six patients were recruited and allocated to the good (n = 22) or poor (n = 54) outcome groups. Of the 20 HRV-related variables, ln very-low frequency (ln VLF) power, detrended fluctuation analysis (DFA) (α1), and multiscale entropy (MSE) index significantly differed between the groups (p = 0.001), with a statistically significant odds ratio (OR) by univariate logistic regression analysis (p = 0.001). Multivariate logistic regression analysis of the 3 variables identified ln VLF power and DFA (α1) as significant predictors for poor outcome (OR = 0.436, p = 0.006 and OR = 0.709, p = 0.024, respectively). The area under the receiver operating characteristic curve for ln VLF power and DFA (α1) in predicting poor outcome was 0.84 and 0.82, respectively. In addition, the minimum value of ln VLF power or DFA (α1) for the good outcome group predicted poor outcome with sensitivity = 61% and specificity = 100%. Conclusions The present data indicate that HRV analysis could be useful for prognostication for comatose patients during hypothermic TTM.
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Affiliation(s)
- Hiroshi Endoh
- Department of Emergency & Critical Care Medicine, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan. .,Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan.
| | - Natuo Kamimura
- Department of Emergency & Critical Care Medicine, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan.,Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Hiroyuki Honda
- Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
| | - Masakazu Nitta
- Advanced Emergency and Critical Care Center, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata, 951-8520, Japan
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Badke CM, Marsillio LE, Weese-Mayer DE, Sanchez-Pinto LN. Autonomic Nervous System Dysfunction in Pediatric Sepsis. Front Pediatr 2018; 6:280. [PMID: 30356758 PMCID: PMC6189408 DOI: 10.3389/fped.2018.00280] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/14/2018] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) plays a major role in maintaining homeostasis through key adaptive responses to stress, including severe infections and sepsis. The ANS-mediated processes most relevant during sepsis include regulation of cardiac output and vascular tone, control of breathing and airway resistance, inflammation and immune modulation, gastrointestinal motility and digestion, and regulation of body temperature. ANS dysfunction (ANSD) represents an imbalanced or maladaptive response to injury and is prevalent in pediatric sepsis. Most of the evidence on ANSD comes from studies of heart rate variability, which is a marker of ANS function and is inversely correlated with organ dysfunction and mortality. In addition, there is evidence that other measures of ANSD, such as respiratory rate variability, skin thermoregulation, and baroreflex and chemoreflex sensitivity, are associated with outcomes in critical illness. The relevance of understanding ANSD in the context of pediatric sepsis stems from the fact that it might play an important role in the pathophysiology of sepsis, is associated with outcomes, and can be measured continuously and noninvasively. Here we review the physiology and dysfunction of the ANS during critical illness, discuss methods for measuring ANS function in the intensive care unit, and review the diagnostic, prognostic, and therapeutic value of understanding ANSD in pediatric sepsis.
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Affiliation(s)
- Colleen M. Badke
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lauren E. Marsillio
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Debra E. Weese-Mayer
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Autonomic Medicine in Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Stanley Manne Children's Research Institute, Chicago, IL, United States
| | - L. Nelson Sanchez-Pinto
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Stanley Manne Children's Research Institute, Chicago, IL, United States
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Chen IC, Kor CT, Lin CH, Kuo J, Tsai JZ, Ko WJ, Kuo CD. High-frequency power of heart rate variability can predict the outcome of thoracic surgical patients with acute respiratory distress syndrome on admission to the intensive care unit: a prospective, single-centric, case-controlled study. BMC Anesthesiol 2018; 18:34. [PMID: 29609546 PMCID: PMC5880002 DOI: 10.1186/s12871-018-0497-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/20/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The morbidity and mortality of acute respiratory distress syndrome (ARDS) remains high, and the strategic focus of ARDS research has shifted toward identifying patients at high risk of mortality early in the course of illness. This study intended to identify the heart rate variability (HRV) measure that can predict the outcome of patients with ARDS on admission to the surgical intensive care unit (SICU). METHODS Patients who had lung or esophageal cancer surgery were included either in the ARDS group (n = 21) if they developed ARDS after surgery or in the control group (n = 11) if they did not. The ARDS patients were further stratified into survivors and non-survivors subgroups according to their outcomes. HRV measures of the patients were used for statistical analysis. RESULTS The mean RR interval (mRRI), high-frequency power (HFP) and product of low-/high-frequency power ratio tidal volume and tidal volume (LHR*VT) were significantly lower (p < 0.05), while the normalized HFP to VT ratio (nHFP/VT) was significantly higher in the ARDS patients (p = 0.011). The total power (TP), low-frequency power (LFP), HFP and HFP/VT were all significantly higher in the non-survived ARDS patients, whereas Richmond Agitation-Sedation Scale (RASS) was significantly lower in the non-survived ARDS patients. After adjustment for RASS, age and gender, firth logistic regression analysis identified the HFP, TP as the significant independent predictors of mortality for ARDS patients. CONCLUSIONS The vagal modulation of thoracic surgical patients with ARDS was enhanced as compared to that of non-ARDS patients, and the non-survived ARDS patients had higher vagal activity than those of survived ARDS patients. The vagal modulation-related parameters such as TP and HFP were independent predictors of mortality in patients with ARDS on admission to the SICU, and the HFP was found to be the best predictor of mortality for those ARDS patients. Increased vagal modulation might be an indicator for poor prognosis in critically ill patients following thoracic surgery.
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Affiliation(s)
- I-Chen Chen
- Intensive Care Units, National Taiwan University Hospital, Taipei, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Jane Kuo
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jang-Zern Tsai
- Department of Electrical Engineering, National Central University, Jung-Li Taoyuan, Taiwan
| | - Wen-Je Ko
- Intensive Care Units, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Deng Kuo
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Chen YJ, Hwang SL, Li CR, Yang CC, Huang KL, Lin CY, Lee CY. Vagal withdrawal and psychological distress during ventilator weaning and the related outcomes. J Psychosom Res 2017; 101:10-16. [PMID: 28867413 DOI: 10.1016/j.jpsychores.2017.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study investigated the associations between changes in autonomic nervous system (ANS) function, psychological status during the mechanical ventilation (MV) weaning process, and weaning outcomes. METHODS In this prospective study, we recruited 67 patients receiving MV for >24h at a medical center in northern Taiwan. Patients' ANS function, represented by heart rate variability (HRV), the rapid shallow breathing index (RSBI), anxiety, fear, and dyspnea, was repeatedly measured 10min before and 30min after undergoing a weaning trial. Forty-nine patients capable of sustaining a 2-h weaning trial were successfully weaned. RESULTS Compared with the failed group, the success group showed significantly smaller decreases in high-frequency HRV (HRV-HF) and smaller increases in RSBI (per 10 breaths/min/L), fear, dyspnea, and anxiety in response to the weaning trial (odds ratio [OR]=2.19, 0.81, 0.69, 0.66, and 0.77, respectively; p<0.05). Multivariate analyses revealed that low-frequency HRV before weaning (OR=2.32; 95% confidence interval [CI]=1.13-4.78, p=0.02), changes in HRV-HF (OR=3.33; 95% CI=1.18-9.44, p=0.02), and psychological fear during the weaning process (OR=0.50; 95% CI=0.27-0.92, p=0.03) were three independent factors associated with 2-h T-piece weaning success. CONCLUSIONS ANS responses and psychological distress during weaning were associated with T-piece weaning outcomes and may reflect the need for future studies to utilize these factors to guide weaning processes and examine their impact on outcomes.
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Affiliation(s)
- Yu-Ju Chen
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.
| | - Shiow-Li Hwang
- Department of Nursing, Asia University, Taichung, Taiwan
| | - Chi-Rong Li
- Department of Teaching and Research, Taichung Hospital, Ministry of Health and Welfare, Taiwan
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Lun Huang
- Hyperbaric Oxygen Therapy Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Yuan Lin
- Department of Surgery, National Defense Medical Center, Division of Cardiovascular Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Yi Lee
- Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, Taipei, Taiwan
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Karmali SN, Sciusco A, May SM, Ackland GL. Heart rate variability in critical care medicine: a systematic review. Intensive Care Med Exp 2017; 5:33. [PMID: 28702940 PMCID: PMC5507939 DOI: 10.1186/s40635-017-0146-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart rate variability (HRV) has been used to assess cardiac autonomic activity in critically ill patients, driven by translational and biomarker research agendas. Several clinical and technical factors can interfere with the measurement and/or interpretation of HRV. We systematically evaluated how HRV parameters are acquired/processed in critical care medicine. METHODS PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (1996-2016) were searched for cohort or case-control clinical studies of adult (>18 years) critically ill patients using heart variability analysis. Duplicate independent review and data abstraction. Study quality was assessed using two independent approaches: Newcastle-Ottowa scale and Downs and Black instrument. Conduct of studies was assessed in three categories: (1) study design and objectives, (2) procedures for measurement, processing and reporting of HRV, and (3) reporting of relevant confounding factors. RESULTS Our search identified 31/271 eligible studies that enrolled 2090 critically ill patients. A minority of studies (15; 48%) reported both frequency and time domain HRV data, with non-normally distributed, wide ranges of values that were indistinguishable from other (non-critically ill) disease states. Significant heterogeneity in HRV measurement protocols was observed between studies; lack of adjustment for various confounders known to affect cardiac autonomic regulation was common. Comparator groups were often omitted (n = 12; 39%). This precluded meaningful meta-analysis. CONCLUSIONS Marked differences in methodology prevent meaningful comparisons of HRV parameters between studies. A standardised set of consensus criteria relevant to critical care medicine are required to exploit advances in translational autonomic physiology.
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Affiliation(s)
- Shamir N Karmali
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Alberto Sciusco
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Shaun M May
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Gareth L Ackland
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK.
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Tsutsumi M, Nogaki H, Shimizu Y, Stone TE, Kobayashi T. Individual reactions to viewing preferred video representations of the natural environment: A comparison of mental and physical reactions. Jpn J Nurs Sci 2016; 14:3-12. [PMID: 27160351 DOI: 10.1111/jjns.12131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
Abstract
AIM Globally, awareness of the vital link between health and the natural environment is growing. This pilot study, based on the idea of "forest bathing," or shinrin-yoku, the mindful use of all five senses to engage with nature in a natural environment, was initiated in order to determine whether stimulation by viewing an individual's preferred video of sea or forest had an effect on relaxation. METHODS The participants were 12 healthy men in their twenties and they were divided into two groups based on their preference for sea or forest scenery by using the Visual Analogue Scale. The participants watched 90 min DVDs of sea with natural sounds and forest with natural sounds while their heart rate variability and Bispectral Index System value were measured by using MemCalc/Tawara and a Bispectral Index System monitor. RESULTS The participants were divided into two groups of six based on their preference for sea or forest scenery and each indicator was compared between them. Significant differences in a decrease in heart rate, increase in high frequency, and sustained arousal level were observed while viewing the preferred video. These results indicated that the viewing individual's preferred video of sea or forest had a relaxation effect. CONCLUSION This study suggests that individual preferences should be taken into consideration for video relaxation therapy.
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Affiliation(s)
- Masae Tsutsumi
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroshi Nogaki
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshihisa Shimizu
- Department of Medical Life Science, Kyushu University of Health and Welfare, Nobeoka, Japan
| | - Teresa Elizabeth Stone
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Toshio Kobayashi
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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12
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Güntzel Chiappa AM, Chiappa GR, Cipriano G, Moraes RS, Ferlin EL, Borghi-Silva A, Vieira SR. Spontaneous breathing trial in T-tube negatively impact on autonomic modulation of heart rate compared with pressure support in critically ill patients. CLINICAL RESPIRATORY JOURNAL 2015; 11:489-495. [PMID: 26269215 DOI: 10.1111/crj.12363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/29/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Spontaneous breathing with a conventional T-piece (TT) connected to the tracheal tube orotraqueal has been frequently used in clinical setting to weaning of mechanical ventilation (MV), when compared with pressure support ventilation (PSV). However, the acute effects of spontaneous breathing with TT versus PSV on autonomic function assessed through heart rate variability (HRV) have not been fully elucidated. OBJECTIVE The purpose of this study was to examine the acute effects of spontaneous breathing in TT vs PSV in critically ill patients. METHOD Twenty-one patients who had received MV for ≥ 48 h and who met the study inclusion criteria for weaning were assessed. Eligible patients were randomized to TT and PSV. Cardiorespiratory responses (respiratory rate -ƒ, tidal volume-VT , mean blood pressure (MBP) and diastolic blood pressure (DBP), end tidal dioxide carbone (PET CO2 ), peripheral oxygen saturation (SpO2 ) and HRV indices in frequency domain (low-LF, high frequency (HF) and LF/HF ratio were evaluated. RESULTS TT increased ƒ (20 ± 5 vs 25 ± 4 breaths/min, P<0.05), MBP (90 ± 14 vs 94 ± 18 mmHg, P<0.05), HR (90 ± 17 vs 96 ± 12 beats/min, P<0.05), PET CO2 (33 ± 8 vs 48 ± 10 mmHg, P<0.05) and reduced SpO2 (98 ± 1.6 vs 96 ± 1.6%, P<0.05). In addition, LF increased (47 ± 18 vs 38 ± 12 nu, P<0.05) and HF reduced (29 ± 13 vs 32 ± 16 nu, P<0.05), resulting in higher LF/HF ratio (1.62 ± 2 vs 1.18 ± 1, P<0.05) during TT. Conversely, VT increased with PSV (0.58 ± 0.16 vs 0.50 ± 0.15 L, P<0.05) compared with TT. CONCLUSION Acute effects of TT mode may be closely linked to cardiorespiratory mismatches and cardiac autonomic imbalance in critically ill patients.
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Affiliation(s)
| | - Gaspar R Chiappa
- Exercise Pathophysiology Research Laboratory and Cardiology Division, Hospital de Clinicas de Porto Alegre, Brazil
| | | | - Ruy S Moraes
- Department of Medicine, Faculty of Medicine, Federal University of Rio Grande Sul, Brazil
| | - Elton L Ferlin
- Biomedical Engineering, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, São Carlos, SP, Brazil
| | - Silvia R Vieira
- Intensive Medicine Service, Hospital de Clinicas de Porto Alegre, Brazil
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Holder AL, Clermont G. Using what you get: dynamic physiologic signatures of critical illness. Crit Care Clin 2015; 31:133-64. [PMID: 25435482 DOI: 10.1016/j.ccc.2014.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The development and resolution of cardiopulmonary instability take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in physiologic signatures. When primary variables are collected with high enough frequency to derive new variables, this data hierarchy can be used to develop physiologic signatures. The creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exist. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve outcomes.
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Affiliation(s)
- Andre L Holder
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gilles Clermont
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Green GC, Bradley B, Bravi A, Seely AJE. Continuous multiorgan variability analysis to track severity of organ failure in critically ill patients. J Crit Care 2013; 28:879.e1-11. [PMID: 23726387 DOI: 10.1016/j.jcrc.2013.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/04/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the utility of using continuous heart rate variability (HRV) and respiratory rate variability (RRV) monitoring for (a) tracking daily organ dysfunction in critically ill patients and (b) identifying patterns of variability changes during onset of shock and resolution of respiratory failure. MATERIALS AND METHODS Thirty-three critically ill patients experiencing respiratory and/or cardiac failure underwent continuous recording of their electrocardiogram and capnogram (CO2) waveforms from admission or intubation until discharge (maximum 14 days). HRV and RRV were computed in 5-minute overlapping windows, using Continuous Individualized Multi-organ Variability Analysis software. Multiple organ dysfunction scores were recorded daily. HRV and RRV trajectories were characterized during onset of shock and resolution of respiratory failure. RESULTS Both HRV and RRV decreased with increasing severity of multiple organ dysfunction scores for a variety of variability metrics. A decline in several measures of HRV and no decline in RRV were observed before onset of shock (n=6). In contrast, during resolution of respiratory failure, an increase in RRV was observed in patients who successfully passed extubation (n=12), with no change in RRV in those who subsequently failed extubation (n=2). CONCLUSIONS There is an association between reduced HRV and RRV and increasing organ dysfunction in critically ill patients. The significance of observing trends of decreasing HRV (with onset of shock) and increasing RRV (with resolution of respiratory failure) merits further investigation.
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Impact of sedation and organ failure on continuous heart and respiratory rate variability monitoring in critically ill patients: a pilot study. Crit Care Med 2013; 41:433-44. [PMID: 23263615 DOI: 10.1097/ccm.0b013e31826a47de] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our aim is to better characterize the impact of sedation and its interruption on continuously monitored heart rate variability and respiratory rate variability in critically ill patients. We aim to explore whether sedation reduces heart rate variability and respiratory rate variability in critically ill patients and whether the extent of reduction depends on degree of organ dysfunction. DESIGN Prospective observational pilot study. SETTING Intensive care unit in tertiary care teaching hospital. PATIENTS Thirty-three critically ill adult patients experiencing respiratory and/or cardiac failure. INTERVENTIONS Electrocardiogram and end-tidal capnography waveform capture were initiated from admission or intubation, respectively, and continued to intensive care unit discharge or a maximum of 14 d. MEASUREMENTS AND MAIN RESULTS All patient days with a sedation interruption (defined as cessation of a continuous infusion of sedation agent) were identified. Mean heart rate variability and respiratory rate variability were computed over two periods: 4 hrs directly prior to the sedation interruption, and the duration of sedation interruption (median: 1 hr 45 mins, interquartile range: 4 hrs 15 mins or max 4 hrs). Severity of organ dysfunction was assessed through multiple organ dysfunction syndrome scores, and sedative agents were recorded for each sedation interruption. Multiple organ dysfunction syndrome levels were defined as low (0-2), medium (3-4), and high (> 4). Variability before and during sedation interruption was compared and analyzed across multiple organ dysfunction syndrome levels and sedative types. Our results suggest that both heart rate variability and respiratory rate variability increased during sedation interruption (p < 0.05 for coefficient of variation). Patients with low and medium multiple organ dysfunction syndrome experienced greater increase in heart rate variability during sedation interruption (p < 0.05 for coefficient of variation), compared to patients with high multiple organ dysfunction syndrome, who failed to mount a significant increase in heart rate variability when sedation was stopped. Similarly, sedation interruption led to increased respiratory rate variability for low multiple organ dysfunction syndrome patients (p < 0.05 for SD), but in contrast, a further deterioration in respiratory rate variability occurred in the high multiple organ dysfunction syndrome patients. All trends persisted when controlling for sedative agents. CONCLUSIONS Interruption of sedation allows for uncovering a greater restoration of heart rate variability and respiratory rate variability in patients with low organ failure. The further reduction in respiratory variability during the elimination of sedation in patients with high multiple organ dysfunction syndrome suggests a differential response and benefit from sedation interruption, and merits further investigation. As reduced variability correlates with severity of illness, and need for sedation depends on organ failure, variability monitoring may offer a dynamic measure of a variable response to the benefit, timing, and duration of sedation interruption.
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Junttila E, Vaara M, Koskenkari J, Ohtonen P, Karttunen A, Raatikainen P, Ala-Kokko T. Repolarization Abnormalities in Patients with Subarachnoid and Intracerebral Hemorrhage. Anesth Analg 2013; 116:190-7. [DOI: 10.1213/ane.0b013e318270034a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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17
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Kato I, Kusaka T, Nishida T, Koyano K, Nakamura S, Nakamura M, Konishi Y, Kunikata J, Jinnai W, Yasuda S, Okada H, Itoh S, Isobe K. Extrauterine environment influences spontaneous low-frequency oscillations in the preterm brain. Brain Dev 2013; 35:17-25. [PMID: 22534236 DOI: 10.1016/j.braindev.2012.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 02/04/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
Low-frequency oscillations in cerebral blood flow that are suggestive of resting-state brain activity have recently been reported, but no study on the development of resting-state brain activity in preterm infants has been performed. The objective of this study was to measure the cerebral blood flow oscillations, which are assumed to represent brain function in the resting state, in preterm and term infants of the same postconceptional age. The subjects were 9 preterm infants who had reached full term (gestational age (GA): 23-34 weeks, postconceptional age: 37-46 weeks) and 10 term infants (GA: 37-40 weeks, postconceptional age: 37-41 weeks). Their changes in concentration of oxyhemoglobin ([oxyHb]) and deoxyhemoglobin ([deoxyHb]) were measured in the parieto-temporal region during quiet sleep using multi-channel near-infrared spectroscopy, and the power spectral densities (PSD) of the oscillations in the concentrations of these molecules were analyzed and compared. The preterm infants displayed a higher proportion of 0.06-0.10 Hz low frequency oscillations of [oxyHb] and [deoxyHb] than the term infants, and the gestational age and the proportion of low frequency oscillations were inversely correlated. These findings suggest that resting-state cerebral blood flow oscillations differ between preterm and term infants, and that the development of circulatory regulation and nerve activity in preterm infants are influenced by the extrauterine environment.
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Affiliation(s)
- Ikuko Kato
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Heart rate variability is an independent predictor of morbidity and mortality in hemodynamically stable trauma patients. ACTA ACUST UNITED AC 2011; 70:1371-80. [PMID: 21817974 DOI: 10.1097/ta.0b013e31821858e6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reduced heart rate variability (HRV) reflects autonomic dysfunction and can triage patients better than routine trauma criteria or vital signs. However, there is questionable specificity and no consensus measurement technique. The purpose of this study was to analyze whether factors that alter autonomic function affect the specificity of HRV for assessing traumatic injury. METHODS We evaluated 216 hemodynamically stable adults (3:1 M:F; 97:3 blunt:penetrating; age 49 years ± 1 year, mean ± standard error) undergoing computed axial tomography (CT) scan to rule out traumatic brain injury (TBI). All were prospectively instrumented with a Mars Holter system (GE Healthcare, Milwaukee, WI). HRV was determined offline using time domain (standard deviation of normal-normal intervals, root-mean-square successive difference) and frequency domain (very low frequency [VLF], LF, wideband frequency, high frequency [HF], low to HF index ratio) calculations from 15-minute electrocardiogram and correlated with routine vital signs, mortality, TBI, morbidity, length of stay (LOS), and comorbidities. Significance (p ≤ 0.05) was determined using nonparametric analysis, Student's t test, analysis of variance, or multiple logistic regression. RESULTS VLF alone predicted survival, severity of TBI, intensive care unit LOS, and hospital LOS (all p < 0.05). Beta-blockers or diabetes had no effect, whereas age, sedation, mechanical ventilation, spinal cord injury, and intoxication influenced one or more of the variables with age being the most powerful confounder (all p < 0.05). Except for the Glasgow Coma Scale, no other routine trauma or hemodynamic criteria correlated with any of these outcomes. CONCLUSIONS Decreased VLF is an independent predictor of mortality and morbidity in hemodynamically stable trauma patients. Other time and other frequency domain variables correlated with some, but not all, outcomes. All were heavily influenced by factors that alter autonomic function, especially patient age.
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Mazzeo AT, La Monaca E, Di Leo R, Vita G, Santamaria LB. Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care. Acta Anaesthesiol Scand 2011; 55:797-811. [PMID: 21658013 DOI: 10.1111/j.1399-6576.2011.02466.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The autonomic nervous system (ANS) plays an important role in the human response to various internal and external stimuli, which can modify homeostasis, and exerts a tight control on essential functions such as circulation, respiration, thermoregulation and hormonal secretion. ANS dysfunction may complicate the perioperative course in the surgical patient undergoing anesthesia, increasing morbidity and mortality, and, therefore, it should be considered as an additional risk factor during pre-operative evaluation. Furthermore, ANS dysfunction may complicate the clinical course of critically ill patients admitted to intensive care units, in the case of trauma, sepsis, neurologic disorders and cardiovascular diseases, and its occurrence adversely affects the outcome. In the care of these patients, the assessment of autonomic function may provide useful information concerning pathophysiology, risk stratification, early prognosis prediction and treatment strategies. Given the role of ANS in the maintenance of systemic homeostasis, anesthesiologists and intensivists should recognize as critical the evaluation of ANS function. Measurement of heart rate variability (HRV) is an easily accessible window into autonomic activity. It is a low-cost, non-invasive and simple to perform method reflecting the balance of the ANS regulation of the heart rate and offers the opportunity to detect the presence of autonomic neuropathy complicating several illnesses. The present review provides anesthesiologists and intensivists with a comprehensive summary of the possible clinical implications of HRV measurements, suggesting that autonomic dysfunction testing could potentially represent a diagnostic and prognostic tool in the care of patients both in the perioperative setting as well as in the critical care arena.
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Affiliation(s)
- Anna Teresa Mazzeo
- Anaesthesia and NeuroIntensive Care Unit, Department of Neurosciences, Psychiatry and Anaesthesiology, University of Messina, Messina, Italy.
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Beda A, Carvalho NC, Güldner A, Koch T, de Abreu MG. Mechanical ventilation during anaesthesia: challenges and opportunities for investigating the respiration-related cardiovascular oscillations. ACTA ACUST UNITED AC 2011; 56:195-206. [PMID: 21728908 DOI: 10.1515/bmt.2011.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The vast majority of the available literature regarding cardiovascular oscillations refers to spontaneously breathing subjects. Only a few studies investigated cardiovascular oscillations, and especially respiration-related ones (RCVO), during intermittent positive pressure mechanical ventilation (IPPV) under anaesthesia. Only a handful considered assisted IPPV, in which spontaneous breathing activity is supported, rather than replaced as in controlled IPPV. In this paper, we review the current understanding of RCVO physiology during IPPV, from literature retrieved through PubMed website. In particular, we describe how during controlled IPPV under anaesthesia respiratory sinus arrhythmia appears to be generated by non-neural mechano-electric feedback in the heart (indirectly influenced by tonic sympathetic regulation of vascular tone and heart contractility) and not by phasic vagal modulation of central origin and/or baroreflex mechanisms. Furthermore, assisted IPPV differs from controlled IPPV in terms of RCVO, reintroducing significant central respiratory vagal modulation of respiratory sinus arrhythmia. This evidence indicates against applying to IPPV interpretative paradigms of RCVO derived from spontaneously breathing subjects, and against considering together IPPV and spontaneously breathing subjects for RCVO-based risk assessment. Finally, we highlight the opportunities that IPPV offers for future investigations of RCVO genesis and interactions, and we indicate several possibilities for clinical applications of RCVO during IPPV.
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Affiliation(s)
- Alessandro Beda
- Pulmonary Engineering Group, Clinic of Anaesthesiology and Intensive Care Therapy, University Clinic Dresden, Germany
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21
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Interrelations entre ventilation mécanique et système nerveux autonome. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Van de Louw A, Médigue C, Papelier Y, Cottin F. Positive end-expiratory pressure may alter breathing cardiovascular variability and baroreflex gain in mechanically ventilated patients. Respir Res 2010; 11:38. [PMID: 20403192 PMCID: PMC2868796 DOI: 10.1186/1465-9921-11-38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 04/19/2010] [Indexed: 01/31/2023] Open
Abstract
Background Baroreflex allows to reduce sudden rises or falls of arterial pressure through parallel RR interval fluctuations induced by autonomic nervous system. During spontaneous breathing, the application of positive end-expiratory pressure (PEEP) may affect the autonomic nervous system, as suggested by changes in baroreflex efficiency and RR variability. During mechanical ventilation, some patients have stable cardiorespiratory phase difference and high-frequency amplitude of RR variability (HF-RR amplitude) over time and others do not. Our first hypothesis was that a steady pattern could be associated with reduced baroreflex sensitivity and HF-RR amplitude, reflecting a blunted autonomic nervous function. Our second hypothesis was that PEEP, widely used in critical care patients, could affect their autonomic function, promoting both steady pattern and reduced baroreflex sensitivity. Methods We tested the effect of increasing PEEP from 5 to 10 cm H2O on the breathing variability of arterial pressure and RR intervals, and on the baroreflex. Invasive arterial pressure, ECG and ventilatory flow were recorded in 23 mechanically ventilated patients during 15 minutes for both PEEP levels. HF amplitude of RR and systolic blood pressure (SBP) time series and HF phase differences between RR, SBP and ventilatory signals were continuously computed by complex demodulation. Cross-spectral analysis was used to assess the coherence and gain functions between RR and SBP, yielding baroreflex-sensitivity indices. Results At PEEP 10, the 12 patients with a stable pattern had lower baroreflex gain and HF-RR amplitude of variability than the 11 other patients. Increasing PEEP was generally associated with a decreased baroreflex gain and a greater stability of HF-RR amplitude and cardiorespiratory phase difference. Four patients who exhibited a variable pattern at PEEP 5 became stable at PEEP 10. At PEEP 10, a stable pattern was associated with higher organ failure score and catecholamine dosage. Conclusions During mechanical ventilation, stable HF-RR amplitude and cardiorespiratory phase difference over time reflect a blunted autonomic nervous function which might worsen as PEEP increases.
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Affiliation(s)
- Andry Van de Louw
- Unité de Biologie Intégrative des Adaptations à l'Exercice (INSERM 902/EA 3872, Genopole), ZAC du Bras de Fer, 3 bis impasse Christophe Colomb, 91000 Evry, France.
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