Decomplexification in critical illness and injury: Relationship between heart rate variability, severity of illness, and outcome

Goldstein, Brahm; Fiser, Debra H.; Kelly, Mary Margaret; Mickelsen, Deanne; Ruttimann, Urs E.; Pollack, Murray M.

doi:10.1097/00003246-199802000-00040

Cited by 163 publications

(94 citation statements)

References 27 publications

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“…In pediatric and adult studies, the sustained reduction of HRV has been correlated with the severity of illness, outcome and mortality rate (26)(27)(28)(29). When assessing outcome in neonates, Vergales et al found that neonates who died had lower SDNN compared to survivors (10 ± 5.1 ms vs. 24.3 ± 9.5 ms, P < 0.001) (12).…”

Section: Neurodevelopmental Outcomementioning

confidence: 99%

Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome

et al. 2015

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Background:The study aims to describe heart rate variability (HRV) in neonatal hypoxic ischemic encephalopathy (HIE) and correlate HRV with electroencephalographic (EEG) grade of HIE and neurodevelopmental outcome. Methods: Multichannel EEG and electrocardiography (ECG) were assessed at 12-48 h after birth in healthy and encephalopathic full-term neonates. EEGs were graded (normal, mild, moderate, and severe). Neurodevelopmental outcome was assessed at 2 y of age. Seven HRV features were calculated using normalized-RR (NN) interval. The correlation of these features with EEG grade and outcome were measured using Spearman's correlation coefficient. results: HRV was significantly associated with HIE severity (P < 0.05): standard deviation of NN interval (SDNN) (r = −0.62), triangular interpolation of NN interval histogram (TINN) (r = −0.65), mean NN interval (r = −0.48), and the very low frequency (VLF) (r = −0.60), low frequency (LF) (r = −0.67) and high frequency (HF) components of the NN interval (r = −0.60). SDNN at 24 and 48 h were significantly associated (P < 0.05) with neurodevelopmental outcome (r = −0.41 and −0.54, respectively). conclusion: HRV is associated with EEG grade of HIE and neurodevelopmental outcome. HRV has potential as a prognostic tool to complement EEG.

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Section: Neurodevelopmental Outcomementioning

confidence: 99%

Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome

et al. 2015

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“…27 Several researchers have demonstrated that low or decreasing HRV in intensive care unit (ICU) patients reflects greater severity of illness and predicts subsequent deterioration and mortality. [28][29][30][31][32][33] HRV analysis measures may provide the emergency physician with a readily available, noninvasive tool to identify patients with early systemic compromise who are at greatest risk for deterioration.…”

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confidence: 99%

Heart Rate Variability in Emergency Department Patients with Sepsis

Barnaby

2002

Academic Emergency Medicine

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Objective: To test the hypothesis that heart rate variability (HRV) can provide an early indication of illness severity among patients presenting to the emergency department (ED) with sepsis. Methods: The authors enrolled a convenience sample of 15 ED patients meeting the American College of Chest Physicians/Society of Critical Care Medicine criteria for sepsis. Each patient had continuous Holter monitoring performed in the ED. Acute Physiology and Chronic Health II (APACHE II) and Sequential Organ Failure (SOFA) scores were calculated for the day of presentation. Holter tapes obtained in the ED were analyzed off-line to calculate HRV variables for the 5-minute segment with the least artifact and non-sinus beats. These variables were correlated with APACHE II and SOFA scores. Results: LFnu (normalized low-frequency power), an assessment of the relative sympathetic contribution to overall HRV, was correlated with increased illness severity as calculated using APACHE II (r = Ϫ0.67, r 2 = 0.43) and SOFA (r = Ϫ0.80, r 2 = 0.64) scores. LF/HF ratio (low-frequency/high-frequency ratio), a measure of sympathovagal balance, was correlated with the SOFA score [r = Ϫ0.54 (95% CI = Ϫ0.83 to Ϫ0.01), r 2 = 0.29]. All five patients who required critical care monitoring or ventilatory support or who died during the first 5 days of their hospitalization had LFnu values below 0.5 and LF/HF ratios less than 1.0. None of the patients with measurements greater than these threshold values died or required these interventions during the five days following admission. Conclusions: A single variable, LFnu, which reflects sympathetic modulation of heart rate, accounted for 40-60% of the variance in illness severity scores among patients presenting to the ED with sepsis. HRV, as reflected in LFnu and the LF/HF ratio and measured with a single brief (5-minute) period of monitoring while in the ED, may provide the emergency physician with a readily available, noninvasive, early marker of illness severity. The threshold effect of LFnu and LF/HF in the prediction of early clinical deterioration was an unexpected finding and should be regarded as hypothesis-generating, pending further study.

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“…The Vanderbilt University group demonstrated that HR variability is a good predictor of mortality in trauma patients as early as 12 h after admission and throughout ICU stay. 34---36 Correlations have also been reported between HR variability and severity of illness and outcome in critically ill and injured children 37 and diverse populations of critical ill patients. 38 In the present study, mortality was found to be related to the alteration of three vital constants and to the duration of the alteration, allowing all three to be used in a prognostic index with an acceptable discrimination capacity.…”

Section: Most Frequent Diagnosesmentioning

confidence: 99%

Relationship between mortality and first-day events index from routinely gathered physiological variables in ICU patients

Rivera-Fernández

Castillo-Lorente

Nap

et al. 2012

Medicina Intensiva (English Edition)

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Objective: To test the hypothesis that the degree and duration of alterations in physiological variables routinely gathered by intensive care unit (ICU) monitoring systems during the first day of admission to the ICU, together with a few additional routinely recorded data, yield information similar to that obtained by traditional mortality prediction systems. Design: A prospective observational multicenter study (EURICUS II) was carried out. Setting: Fifty-five European ICUs. Patients: A total of 17,598 consecutive patients admitted to the ICU over a 10-month period. Interventions: None. Main variables of interest:Hourly data were manually gathered on alterations or ''events'' in systolic blood pressure, heart rate and oxygen saturation throughout ICU stay to construct an events index and mortality prediction models. Results: The mean first-day events index was 6.37 ± 10.47 points, and was significantly associated to mortality (p < 0.001), with a discrimination capacity for hospital mortality of 0.666 (area under the ROC curve). A second index included this first-day events index, age, preadmission location, and the Glasgow coma score. A model constructed with this second index plus diagnosis upon admission was validated by using the Jackknife method (Hosmer-Lemeshow, H = 13.8554, insignificant); the area under ROC curve was 0.818. Conclusions: A prognostic index with performance very similar to that of habitual systems can be constructed from routine ICU data with only a few patient characteristics. These results may serve as a guide for the possible automated construction of ICU prognostic indexes. © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved. * Corresponding author. E-mail address: encarnacion.castillo.sspa@juntadeandalucia.es (E. Castillo-Lorente). Relationship between mortality and first-day events index 635 PALABRAS CLAVE Cuidados Intensivos; Cuidados Críticos; Índices de gravedad; EventosRelación entre la mortalidad y el índice de eventos del primer día de estancia a partir de variables fisiológicas recogidas durante la monitorización rutinaria de pacientes de la UCI Resumen Objetivo: Comprobar si el grado y duración de las alteraciones en las variables fisiológicas recogidas en la monitorización rutinaria en UCI durante el primer día de estancia, junto con pocos datos adicionales, proporcionan información similar a la obtenida con los sistemas tradicionales de predicción de mortalidad. Diseño: Estudio observacional, prospectivo y multicéntrico (EURICUS-II). Ámbito: 55 UCIs de Europa. Pacientes: 17.598 pacientes consecutivos, ingresados durante 10 meses. Intervenciones: ninguna. Variables de interés principales: se recogieron manualmente datos horarios sobre alteraciones o ''eventos'' en la presión arterial sistólica, frecuencia cardiaca y saturación de oxígeno, para construir un índice basado en estos eventos y un modelo de predicción de mortalidad. Resultados: El índice de eventos el primer día fue 6,37 ± 10,47 puntos y se asoció significativamente con la mortalidad (p < 0,001)...

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Decomplexification in critical illness and injury: Relationship between heart rate variability, severity of illness, and outcome

Cited by 163 publications

References 27 publications

Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome

Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome

Heart Rate Variability in Emergency Department Patients with Sepsis

Relationship between mortality and first-day events index from routinely gathered physiological variables in ICU patients

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