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Continuous multiorgan variability analysis to track severity of organ failure in critically ill patients.
MedLine Citation:
PMID:  23726387     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Geoffrey C Green; Beverly Bradley; Andrea Bravi; Andrew J E Seely
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-29
Journal Detail:
Title:  Journal of critical care     Volume:  -     ISSN:  1557-8615     ISO Abbreviation:  J Crit Care     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-6-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: geoffgreen@ieee.org.
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