Heart rate variability for assessing comatose patients with different Glasgow Coma Scale scores

Machado-Ferrer, Yazmina; Estévez, Mario; Machado, Calixto; Hernández-Cruz, Adrián; Frederick, Carrick; Leisman, Gerry; Melillo, Robert; DeFina, Philip A.; Chinchilla, Mauricio; Machado, Yanín

doi:10.1016/j.clinph.2012.09.008

Cited by 18 publications

(22 citation statements)

References 46 publications

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“…Hereafter, the initial complete loss of HF component in our case might be an expression of the progressive destruction of the lower region of the medulla, affecting the vagal nuclei 9 19. A remaining oscillation within the HF band coincided with the life support ventilator frequency.…”

Section: Discussionmentioning

confidence: 53%

“…Baillard et al 2 demonstrated that during the apnoea test in BD cases, these HF frequencies disappeared. Therefore, the artificial ventilator was in fact the driving input with a pure mechanical origin for the generation of this HF peak 2 9…”

Section: Discussionmentioning

confidence: 99%

“…Technical details have been described elsewhere 9. In this study, for the time-varying spectral analysis (TVSPA), spectral estimations included 300 s and a progression step of 5 s. The total number of estimations was 196.…”

Section: Case Presentationmentioning

confidence: 99%

“…The HRV power spectral analysis has been proposed as a tool to diagnose brainstem damage through the assessment of the functional integrity of the autonomic nervous system vital nuclei in this area 9–11. Several authors have also suggested the use of an HRV time-frequency analysis as an indicator of the progressive loss of different HRV bands during the clinical evolution from coma to BD 2 3 9. For example, Baillard et al 2 found that the spectral power in the low-frequency (LF) range reached zero, whereas spectral power in the high-frequency (HF) band persisted weakly.…”

Section: Introductionmentioning

confidence: 99%

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Residual vasomotor activity assessed by heart rate variability in a brain-dead case

et al. 2015

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SUMMARYA patient assessed by heart rate variability (HRV) methodology, beginning just after the completion of brain death (BD) diagnosis, showed remaining very low frequency (VLF) waves for approximately 10 min. A timevarying spectral analysis showed that during the first 550 s, a significant power spectral density remained in the high-frequency (HF), low-frequency (LF) and VLF bands. From 550 to 675 s, the HF oscillations totally vanished, and a marked progressive decay of the LF and VLF power density occurred. After 700 s the VLF undulations stopped and remaining small amplitude oscillations at 0.2 Hz coincided with the ventilator frequency. The VLF oscillations recorded in our case might be related to residual sympathetic vasomotor activity that progressively disappeared due to the extension of necrosis affecting the nervous centres of the lower part of the medulla and the first 2-3 cervical spine segments. BACKGROUND

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Residual vasomotor activity assessed by heart rate variability in a brain-dead case

et al. 2015

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“…It has been shown that the ANS functional state predicts responsiveness in disorders of consciousness [5]. Multiple indices of HRV calculated in the time, frequency or informational domains have been studied in patients in coma with different objectives: to assess brainstem dysfunction [6], to assess brain death [7][8][9], differentiation of autonomic nervous activity in different stages of coma [10], diagnosis of dysautonomia after traumatic brain injuries (TBI) [11], calculation and description of HRV indices of patients in coma [12] correlation of the HRV parameters with the Glasgow coma score (GCS) [13][14][15][16], prediction or prognosis of the outcome in TBI, acute cerebral vascular disease, or critically ill neurosurgical patients [17][18][19][20][21][22][23], association of HRV indices with mortality in patients with TBI [24][25][26][27][28][29][30][31][32], and prediction of life saving interventions in patients with trauma [22,[33][34][35][36][37].…”

Section: Main Text Introductionmentioning

confidence: 99%

Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability

et al. 2019

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Primary objective: To assess and compare the functional state of the autonomic nervous system in healthy individuals with patients in coma using measures of heart rate variability (HRV), and to evaluate its efficiency in predicting mortality. Research design: Retrospective group comparison study of patients in coma, classified into two subgroups, according to their Glasgow coma score, with a healthy control group. Methods and procedures: HRV indices were calculated from 7 minutes of free of artifacts electrocardiograms using the Hilbert-Huang method in the spectral range 0.02-0.6 Hz. A special procedure was applied to avoid the effect of confounding factors. Stepwise multiple regression logistic analysis (SMLRA), followed by ROC curve analysis were applied to evaluate predictions. Results: Progressive reduction of HRV associated with deepening of coma was confirmed and a mortality score model including three spectral HRV indices: absolute power values of the very low, low frequency, and the power in normalized units of the very high frequency bands (0.4-0.6 Hz). The SMLRA model showed sensitivity of 95.65%, specificity of 95.83%, positive predictive value of 95.65%, and overall efficiency of 95.74%. Conclusions: HRV is a reliable method to assess the integrity of the neural control of the caudal brainstem centres upon the heart, of patients in coma, and predict mortality.

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Very High Frequency Oscillations of Heart Rate Variability in Healthy Humans and in Patients with Cardiovascular Autonomic Neuropathy

Estévez‐Báez

Machado

Montes-Brown

et al. 2018

Advances in Experimental Medicine and Biology

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Literature reports on the very high frequency (VHF) range of 0.4-0.9 Hz in heart rate variability (HRV) are scanty. The VHF presence in cardiac transplant patients and other conditions associated with reduced vagal influence on the heart encouraged us to explore this spectral band in healthy subjects and in patients diagnosed with cardiac autonomic neuropathy (CAN), and to assess the potential clinical value of some VHF indices. The study included 80 healthy controls and 48 patients with spinocerebellar ataxia type 2 (SCA2) with CAN. The electrocardiographic recordings of short 5-min duration were submitted to three different spectral analysis methods, including the most generally accepted procedure, and the two novel methods using the Hilbert-Huang transform. We demonstrated the presence of VHF activity in both groups of subjects. However, VHF power spectral density, expressed in relative normalized units, was significantly greater in the SCA2 patients than that in healthy subjects, amounting to 36.1 ± 17.4% vs. 22.9 ± 14.1%, respectively, as also was the instantaneous VHF spectral frequency, 0.58 ± 0.05 vs. 0.64 ± 0.07 Hz, respectively. These findings were related to the severity of CAN. We conclude that VHF activity of HRV is integral to the cardiovascular autonomic control.

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Heart rate variability for assessing comatose patients with different Glasgow Coma Scale scores

Cited by 18 publications

References 46 publications

Residual vasomotor activity assessed by heart rate variability in a brain-dead case

Residual vasomotor activity assessed by heart rate variability in a brain-dead case

Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability

Very High Frequency Oscillations of Heart Rate Variability in Healthy Humans and in Patients with Cardiovascular Autonomic Neuropathy

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