| Heart rate and pulse pressure variability are associated with intractable intracranial hypertension after severe traumatic brain injury. | |
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MedLine Citation:
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PMID: 20622688 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Calculation of integer heart rate variability (HRVi) permits monitoring over extended periods. We asked whether continuous monitoring of HRVi or integer pulse pressure (PP) variability (PPVi) could predict intracranial hypertension, defined as ICP >20 mm Hg, cerebral hypoperfusion, defined as CPP<60 mm Hg, mortality or functional outcome after severe traumatic brain injury. Dense integer data collected during continuous intensive care unit monitoring for periods of 1 to 11 days on 25 patients admitted to our Level I trauma center with Glasgow Coma Scale <9 provided 1,715,000 data points over a mean 106±62 hours. PP, HRVi, and PPVi increased in response to increasing ICP when CPP >60 mm Hg (P<0.001), but HRVi and PPVi decreased when CPP <60 mm Hg and P<50 mm Hg, even with ICP <20 mm Hg (P<0.001). ICP up to 40 mm Hg still evoked an increase in HRVi and PPVi (P<0.001), but both were suppressed with CPP <50 mm Hg and ICP >40 mm Hg (actual or impending brain death). Mean HRVi and PPVi predicted in-hospital mortality (sensitivity, 67%; specificity, 91% to 100%). Combining HRVi and PPVi as an "autonomic index" (AI) best predicted long-term functional outcome [Area Under the Curve: 0.84±0.08 for AI <0.5]. Our data show that HRVi and PPVi can be monitored and calculated automatically and can provide useful prognostic information in patients with severe traumatic brain injury, particularly when combined into a single index. |
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Authors:
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Sibel Kahraman; Richard P Dutton; Peter Hu; Lynn Stansbury; Yan Xiao; Deborah M Stein; Thomas M Scalea |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of neurosurgical anesthesiology Volume: 22 ISSN: 1537-1921 ISO Abbreviation: J Neurosurg Anesthesiol Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-16 Completed Date: 2011-01-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8910749 Medline TA: J Neurosurg Anesthesiol Country: United States |
Other Details:
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Languages: eng Pagination: 296-302 Citation Subset: IM |
Affiliation:
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R Adams Cowley Shock Trauma Center, University of Maryland Shock Trauma Anesthesia Research Organized Research Center, Baltimore, MD, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Area Under Curve Autonomic Nervous System / physiopathology Blood Pressure / physiology* Brain Injuries / complications*, physiopathology* Female Glasgow Coma Scale Glasgow Outcome Scale Heart Rate / physiology* Hospital Mortality Humans Intracranial Hypotension / etiology*, physiopathology* Intracranial Pressure / physiology Male Prognosis ROC Curve Tomography, X-Ray Computed Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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