1
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Harris BR, Beesley SJ, Hopkins RO, Hirshberg EL, Wilson E, Butler J, Oniki TA, Kuttler KG, Orme JF, Brown SM. Heart rate variability and subsequent psychological distress among family members of intensive care unit patients. J Int Med Res 2021; 49:3000605211057829. [PMID: 34846178 PMCID: PMC8649465 DOI: 10.1177/03000605211057829] [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] [Indexed: 01/04/2023] Open
Abstract
Objective To determine whether heart rate variability (HRV; a physiological measure of
acute stress) is associated with persistent psychological distress among
family members of adult intensive care unit (ICU) patients. Methods This prospective study investigated family members of patients admitted to a
study ICU. Participants’ variability in heart rate tracings were measured by
low frequency (LF)/high frequency (HF) ratio and detrended fluctuation
analysis (DFA). Questionnaires were completed 3 months after enrollment to
ascertain outcome rates of anxiety, depression, and post-traumatic stress
disorder (PTSD). Results Ninety-nine participants were enrolled (median LF/HF ratio, 0.92
[interquartile range, 0.64–1.38]). Of 92 participants who completed the
3-month follow-up, 29 (32%) had persistent anxiety. Logistic regression
showed that LF/HF ratio (odds ratio [OR] 0.85, 95% confidence interval [CI]
0.43, 1.53) was not associated with 3-month outcomes. In an exploratory
analysis, DFA α (OR 0.93, 95% CI 0.87, 0.99), α1 (OR 0.97, 95% CI
0.94, 0.99), and α2 (OR 0.94, 95% CI 0.88, 0.99) scaling
components were associated with PTSD development. Conclusion Almost one-third of family members experienced anxiety at three months after
enrollment. HRV, measured by LF/HF ratio, was not a predictor of psychologic
distress, however, exploratory analyses indicated that DFA may be associated
with PTSD outcomes.
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Affiliation(s)
- Benjamin Re Harris
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sarah J Beesley
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ramona O Hopkins
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Psychology Department and Neuroscience Center, 6756Brigham Young University, Brigham Young University, Provo, UT, USA
| | - Eliotte L Hirshberg
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Emily Wilson
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jorie Butler
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Geriatrics and Psychology, University of Utah and Salt Lake City Veterans Administration Hospital, Salt Lake City, UT, USA
| | - Thomas A Oniki
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Care Transformation Information Systems, 7061Intermountain Healthcare, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kathryn G Kuttler
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Care Transformation Information Systems, 7061Intermountain Healthcare, Intermountain Healthcare, Salt Lake City, UT, USA
| | - James F Orme
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Samuel M Brown
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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2
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de Castilho FM, Ribeiro ALP, Nobre V, Barros G, de Sousa MR. Heart rate variability as predictor of mortality in sepsis: A systematic review. PLoS One 2018; 13:e0203487. [PMID: 30204803 PMCID: PMC6133362 DOI: 10.1371/journal.pone.0203487] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autonomic dysregulation is one of the recognized pathophysiological mechanisms in sepsis, generating the hypothesis that heart rate variability (HRV) can be used to predict mortality in sepsis. METHODS This was a systematic review of studies evaluating HRV as a predictor of death in patients with sepsis. The search was performed by independent researchers in PubMed, LILACS and Cochrane, including papers in English, Portuguese or Spanish, indexed until August 20th, 2017 with at least 10 patients. Study quality was assessed by Newcastle-Ottawa Scale. To analyze the results, we divided the articles between those who measured HRV for short-term recordings (≤ 1 hour), and those who did long-term recordings (≥ 24 hours). RESULTS Nine studies were included with a total of 536 patients. All of them were observational studies. Studies quality varied from 4 to 7 stars in Newcastle-Ottawa Scale. The mortality rate in the studies ranged from 8 to 61%. Seven studies performed HRV analysis in short-term recordings. With the exception of one study that did not explain which group had the lowest results, all other studies showed reduction of several HRV parameters in the non-survivors in relation to the surviving septic patients. SDNN (Standard deviation of the Normal to Normal interval), TP (Total Power), VLF (Very Low Frequency Power), LF (Low Frequency Power), LF/HF (Low Frequency Power / High Frequency Power), nLF (Normalized Low Frequency Power), α1/α2 (short-term and long-term fractal scaling coefficients from DFA) and r-MSSD (Square root of the squared mean of the difference of successive NN-intervals) of the non-survivor group were reduced in relation to the survivors in at least one study. Two studies found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors. Three studies performed HRV analysis using long-term recordings. Only one of these studies found difference between surviving and non-surviving groups, and even so, in only one HRV parameter: LogHF. CONCLUSIONS Several HRV parameters are reduced in nonsurviving septic patients in short-term recording. Two studies have found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors.
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Affiliation(s)
- Fábio M. de Castilho
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Antonio Luiz P. Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vandack Nobre
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), UFMG, Belo Horizonte, Brazil
| | - Guilherme Barros
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcos R. de Sousa
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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3
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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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4
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Barnaby DP, Fernando SM, Ferrick KJ, Herry CL, Seely AJE, Bijur PE, Gallagher EJ. Use of the low-frequency/high-frequency ratio of heart rate variability to predict short-term deterioration in emergency department patients with sepsis. Emerg Med J 2017; 35:96-102. [PMID: 28821492 DOI: 10.1136/emermed-2017-206625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the ability of the low-frequency/high-frequency (LF/HF) ratio of heart rate variability (HRV) analysis to identify patients with sepsis at risk of early deterioration. METHODS This is a prospective observational cohort study of patients with sepsis presenting to the Montefiore Medical Center ED from December 2014 through September 2015. On presentation, a single ECG Holter recording was obtained and analysed to obtain the LF/HF ratio of HRV. Initial Sequential Organ Failure Assessment (SOFA) scores were computed. Patients were followed for 72 hours to identify those with early deterioration. RESULTS 466 patients presenting to the ED with sepsis were analysed. Thirty-two (7%) reached at least one endpoint within 72 hours. An LF/HF ratio <1 had a sensitivity and specificity of 34% (95% CI (19% to 53%)) and 82% (95% CI (78% to 85%)), respectively, with positive and negative likelihood ratios of 1.9 (95% CI (1.1 to 3.2)) and 0.8 (95% CI (0.6 to 1.0)). An initial SOFA score ≥3 had a sensitivity and specificity of 38% (95% CI (22% to 56%)) and 92% (95% CI (89% to 95%)), with positive and negative likelihood ratios of 4.9 (95% CI (2.8 to 8.6)) and 0.7 (95% CI (0.5 to 0.9)). The composite measure of HRV+SOFA had improved sensitivity (56%, 95% CI (38% to 73%)) but at the expense of specificity (77%, 95% CI (72% to 80%)), with positive and negative likelihood ratios of 2.4 (95% CI (1.7 to 3.4)) and 0.6 (95% CI (0.4 to 0.9)). Receiver operating characteristic analysis did not identify a superior alternate threshold for the LF/HF ratio. Kaplan-Meier survival functions differed significantly (p=0.02) between low (<1) and high (≥1) LF/HF groups. CONCLUSIONS While we found a statistically significant relationship between HRV, SOFA and HRV+SOFA, and early deterioration, none reliably functioned as a clinical predictive tool. More complex multivariable models will likely be required to construct models with clinical utility.
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Affiliation(s)
- Douglas P Barnaby
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shannon M Fernando
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin J Ferrick
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christophe L Herry
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew J E Seely
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Departments of Surgery and Critical Care Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Polly E Bijur
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - E John Gallagher
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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5
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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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6
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Lu CW, Czosnyka M, Shieh JS, Pickard JD, Smielewski P. Continuous Monitoring of the Complexity of Intracranial Pressure After Head Injury. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 122:33-5. [PMID: 27165872 DOI: 10.1007/978-3-319-22533-3_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Multiscale entropy (MSE) has been increasingly used to investigate the complexity of biological signals. Our previous study demonstrated that the complexity of mean intracranial pressure (ICP), assessed by MSE based on the whole recording periods, is associated with the outcome after traumatic brain injury (TBI). To improve the feasibility of MSE in a clinical setting, this study examined whether the complexity of ICP waveforms based on shorter periods could be a reliable predictor of the outcome in patients with TBI. Results showed that the complexity of ICP slow waves, calculated in 3-h moving windows, correlates with the outcome of patients with TBI. Thus, the complexity of ICP may be a promising index to be incorporated into multimodal monitoring in patients with TBI.
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Affiliation(s)
- Cheng-Wei Lu
- Department of Anaesthesiology, Far-Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Pan-Chiao, New Taipei City, Taiwan. .,Department of Mechanical Engineering, Yuan Ze University, Taoyuan, Taiwan. .,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Jiann-Shing Shieh
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - John D Pickard
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Peter Smielewski
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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7
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Tang Y, Sorenson J, Lanspa M, Grissom CK, Mathews VJ, Brown SM. Systolic blood pressure variability in patients with early severe sepsis or septic shock: a prospective cohort study. BMC Anesthesiol 2017. [PMID: 28623891 PMCID: PMC5473993 DOI: 10.1186/s12871-017-0377-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Severe sepsis and septic shock are often lethal syndromes, in which the autonomic nervous system may fail to maintain adequate blood pressure. Heart rate variability has been associated with outcomes in sepsis. Whether systolic blood pressure (SBP) variability is associated with clinical outcomes in septic patients is unknown. The propose of this study is to determine whether variability in SBP correlates with vasopressor independence and mortality among septic patients. Methods We prospectively studied patients with severe sepsis or septic shock, admitted to an intensive care unit (ICU) with an arterial catheter. We analyzed SBP variability on the first 5-min window immediately following ICU admission. We performed principal component analysis of multidimensional complexity, and used the first principal component (PC1) as input for Firth logistic regression, controlling for mean systolic pressure (SBP) in the primary analyses, and Acute Physiology and Chronic Health Evaluation (APACHE) II score or NEE dose in the ancillary analyses. Prespecified outcomes were vasopressor independence at 24 h (primary), and 28-day mortality (secondary). Results We studied 51 patients, 51% of whom achieved vasopressor independence at 24 h. Ten percent died at 28 days. PC1 represented 26% of the variance in complexity measures. PC1 was not associated with vasopressor independence on Firth logistic regression (OR 1.04; 95% CI: 0.93–1.16; p = 0.54), but was associated with 28-day mortality (OR 1.16, 95% CI: 1.01–1.35, p = 0.040). Conclusions Early SBP variability appears to be associated with 28-day mortality in patients with severe sepsis and septic shock. Electronic supplementary material The online version of this article (doi:10.1186/s12871-017-0377-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi Tang
- Electrical and Computer Engineering, University of Utah, 50 Central Campus Dr #2110, Salt Lake City, UT, 84112, USA
| | - Jeff Sorenson
- Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, Murray, UT, 84107, USA
| | - Michael Lanspa
- Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, Murray, UT, 84107, USA.,Pulmonary and Critical Care, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Colin K Grissom
- Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, Murray, UT, 84107, USA.,Pulmonary and Critical Care, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - V J Mathews
- Electrical and Computer Engineering, University of Utah, 50 Central Campus Dr #2110, Salt Lake City, UT, 84112, USA
| | - Samuel M Brown
- Pulmonary and Critical Care, Intermountain Medical Center, 5121 Cottonwood St, Murray, UT, 84107, USA. .,Pulmonary and Critical Care, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA. .,Shock Trauma Intensive Care Unit, 5121 South Cottonwood Street, Murray, UT, 84107, USA.
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8
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Liu WC, Lin WY, Lin CS, Huang HB, Lin TC, Cheng SM, Yang SP, Lin JC, Lin WS. Prognostic impact of restored sinus rhythm in patients with sepsis and new-onset atrial fibrillation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:373. [PMID: 27855722 PMCID: PMC5114755 DOI: 10.1186/s13054-016-1548-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/31/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND New-onset atrial fibrillation (NeOAF) is a common type of tachyarrhythmia in critically ill patients and is associated with increased mortality in patients with sepsis. However, the prognostic impact of restored sinus rhythm (SR) in septic patients with NeOAF remains unclear. METHODS A total of 791 patients with sepsis, who were admitted to a medical intensive care unit from January 2011 to January 2014, were screened. NeOAF was detected by continuous electrocardiographic monitoring. Patients were categorized into three groups: no NeOAF, NeOAF with restored SR (NeOAF to SR), and NeOAF with failure to restore SR (NeOAF to atrial fibrillation (AF)). The endpoint of this study was in-hospital mortality. Patients with pre-existing AF were excluded. RESULTS We reviewed the data of 503 eligible patients, including 263 patients with no NeOAF and 240 patients with NeOAF. Of these 240 patients, SR was restored in 165 patients, and SR could not be restored in 75 patients. The NeOAF to AF group had the highest in-hospital mortality rate of 61.3% compared with the NeOAF to SR and no NeOAF groups (26.1% and 17.5%, respectively). Moreover, multivariate logistic regression analysis revealed that failure of restored SR was independently associated with increased in-hospital mortality in patients with sepsis and NeOAF. CONCLUSIONS Failure to restore a sinus rhythm in patients with new-onset atrial fibrillation may be associated with increased in-hospital mortality in patients with sepsis. Further prospective studies are needed to clarify the effects of restoration of sinus rhythm on survival in patients with sepsis and new-onset atrial fibrillation.
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Affiliation(s)
- Wen Cheng Liu
- Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan
| | - Wen Yu Lin
- Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan
| | - Chin Sheng Lin
- Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan
| | - Han Bin Huang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Tzu Chiao Lin
- Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan
| | - Shu Meng Cheng
- Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan
| | - Shih Ping Yang
- Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan
| | - Jung Chung Lin
- Division of infectious Diseases and Tropical Medicine, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei Shiang Lin
- Division of Cardiology, Department of Internal medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
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9
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Brown SM, Sorensen J, Lanspa MJ, Rondina MT, Grissom CK, Shahul S, Mathews VJ. Multi-complexity measures of heart rate variability and the effect of vasopressor titration: a prospective cohort study of patients with septic shock. BMC Infect Dis 2016; 16:551. [PMID: 27724850 PMCID: PMC5057204 DOI: 10.1186/s12879-016-1896-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 10/04/2016] [Indexed: 12/20/2022] Open
Abstract
Background Septic shock is a common and often devastating syndrome marked by severe cardiovascular dysfunction commonly managed with vasopressors. Whether markers of heart rate complexity before vasopressor up-titration could be used to predict success of the up-titration is not known. Methods We studied patients with septic shock requiring vasopressor, newly admitted to the intensive care unit. We measured the complexity of heart rate variability (using the ratio of fractal exponents from detrended fluctuation analysis) in the 5 min before all vasopressor up-titrations in the first 24 h of an intensive care unit (ICU) admission. A successful up-titration was defined as one that did not require further up-titration (or decrease in mean arterial pressure) for 60 min. Results We studied 95 patients with septic shock, with a median APACHE II of 27 (IQR: 20–37). The median number of up-titrations, normalized to 24 h, was 12.2 (IQR: 8–17) with a maximum of 49. Of the up-titrations, the median proportion of successful interventions was 0.28 (IQR: 0.12–0.42). The median of mean arterial pressure (MAP) at the time of a vasopressor up-titration was 66 mmHg; the average infusion rate of norepinephrine at the time of an up-titration was 0.11 mcg/kg/min. The ratio of fractal exponents was not associated with successful up-titration on univariate or multivariate regression. On exploratory secondary analyses, however, the long-term fractal exponent was associated (p = 0.003) with success of up-titration. Independent of heart rate variability, MAP was associated (p < 0.001) with success of vasopressor up-titration, while neither Sequential Organ Failure Assessment (SOFA) nor Acute Physiology and Chronic Health Evaluation II (APACHE II) score was associated with vasopressor titration. Conclusions Only a third of vasopressor up-titrations were successful among patients with septic shock. MAP and the long-term fractal exponent were associated with success of up-titration. These two, complementary variables may be important to the development of rational vasopressor titration protocols. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1896-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samuel M Brown
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA. .,Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jeffrey Sorensen
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA
| | - Michael J Lanspa
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA.,Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Matthew T Rondina
- Internal Medicine, University of Utah Medical Center and School of Medicine and George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Molecular Medicine Program in the Eccles Institute of Human Genetics, Salt Lake City, UT, USA
| | - Colin K Grissom
- Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT, USA.,Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sajid Shahul
- Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | - V J Mathews
- School of Electrical Engineering & Computer Science, Oregon State University, Corvallis, OR, USA
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Adams JA, Uryash A, Nadkarni V, Berg RA, Lopez JR. Whole body periodic acceleration (pGz) preserves heart rate variability after cardiac arrest. Resuscitation 2015; 99:20-5. [PMID: 26690649 DOI: 10.1016/j.resuscitation.2015.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
AIMS Heart rate variability (HRV) is a measure of the balance between the sympathetic and parasympathetic autonomic nervous system and lack thereof an ominous sign in many cardiac and neurological conditions including post-cardiac arrest syndrome. Whole body periodic acceleration (pGz) has been shown to be cardio protective when applied prior to during and after cardiac arrest (CA). Here, we investigate whether or not pGz pre or post treatment after CA preserves HRV. METHODS Eight min of unsupported ventricular fibrillation followed by CPR and defibrillation was carried out in 32 anesthetized and paralyzed male swine who were randomized to pretreatment (1h pGz prior to CA, pre-pGz [n=8]) or post-treatment (pGz beginning at 30min after return of spontaneous circulation ([ROSC], post-pGz [n=8]) or none (CONT [n=8]). pGz was applied together with conventional mechanical ventilation. In a separate group (n=8), infusion of TRIM (nNOS inhibitor) was used to determine the effects of nNOS inhibition on HRV. RESULTS Time and frequency domain measures of HRV were determined along with measurements of blood gases and hemodynamics, obtained at baseline and at 30, 60, 120 and 180min after ROSC. All animals had ROSC and there were no significant differences for arterial blood gases, mean blood pressure and coronary perfusion pressure after ROSC among the groups. HRV was significantly depressed after cardiac arrest and remained depressed in CONT group. In contrast, both pre and post pGz treated groups had significantly higher and preserved time domain measures of HRV (RMSSD and SDNN) from 60 to 180min after ROSC, and nNOS inhibition markedly reduced HRV. The frequency domain of HRV did not show changes. CONCLUSIONS In a pig model of CA, pre or post treatment with pGz preserves HRV. Inhibition of nNOS markedly reduced HRV. Post-treatment with pGz is a novel therapeutic strategy that might serve as an adjunct to current pharmacological or hypothermia modalities to potentially improve outcomes from post-cardiac arrest syndrome.
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Affiliation(s)
- Jose A Adams
- Mt Sinai Medical Center, Division of Neonatology, Miami Beach, FL, USA.
| | - Arkady Uryash
- Mt Sinai Medical Center, Division of Neonatology, Miami Beach, FL, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jose R Lopez
- Department of Molecular Biosciences, University of California Davis, Davis, CA, USA
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Pladys P, Vandenbroucke L, Hernandez A, Beuchée A. Intérêt des mesures de variabilité du rythme cardiaque dans le sepsis. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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