Autonomic control of the heart and peripheral vessels in human septic shock

Piepoli, Massimo F; Garrard, C. S.; Kontoyannis, Dimitrios A.; Bernardi, Luciano

doi:10.1007/bf01726532

Cited by 88 publications

(55 citation statements)

References 29 publications

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“…In the present study, LFnu was correlated with both APACHE II [r = Ϫ0.67, (95% CI = Ϫ0.88 to Ϫ0.22), r 2 = 0.45] and SOFA scores [r = Ϫ0.80 (95% CI = Ϫ0.93 to Ϫ0.46), r 2 = 0.64]. While our confidence intervals are wide, these findings are similar to those of Garrard et al 31 and Piepoli et al, 28 who reported similar r-values of Ϫ0.66 and Ϫ0.58, respectively, in their comparisons of LFnu with APACHE II.…”

Section: Discussionsupporting

confidence: 88%

“…However, this limitation was intrinsic to our study design, since our goal was to examine the ability of HRV analysis to identify patients at risk for deterioration from a population of moderately ill ED patients. It is note- worthy that the degree of correlation between APACHE II and LFnu was similar to the results reported by Garrard et al 31 and Piepoli et al 28 in their studies of a ''sicker'' population [Garrard: mean APACHE II = 23 (range 6-41); Piepoli: mean APACHE II = 25 (range 19-31); our study: mean = 14 (range ].…”

Section: Limitationssupporting

confidence: 90%

“…Previous studies of HRV in sepsis have attributed loss of HRV to impaired sympathetic modulation, and have demonstrated an inverse relationship between sympathetically mediated HRV and illness severity. 28,31,33,37 During periods of stress, low-frequency (LF) oscillations (0.04-0.15 Hz) primarily reflect the degree of sym-pathetic modulation, while those in the high-frequency (HF) region (0.15-0.40 Hz) correlate with parasympathetically mediated respiratory sinus arrhythmia. 22,38 For this study, the power spectrum was computed using a fast Fourier transform (FFT) algorithm and values corresponding to total, LF, and HF spectral power were recorded.…”

Section: Study Protocolmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 88%

Section: Limitationssupporting

confidence: 90%

Section: Study Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

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Heart Rate Variability in Emergency Department Patients with Sepsis

Barnaby

2002

Academic Emergency Medicine

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“…Last, the results of our study suggest that caution should be exercised in the inter- pretation of studies on autonomic control in critically ill patients who receive intravenous inotropes. 26 Dobutamine had similar effects on LF and HF variability of the RR interval. RR interval variability normally results from the complex interactions of phasic changes in sympathetic and vagal drive to the sinus node.…”

Section: Discussionmentioning

confidence: 93%

Arterial Baroreflex Control of the Sinus Node During Dobutamine Exercise Stress Testing

et al. 1999

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Abstract-The contributions of increases in circulating catecholamines, changes in central command, and muscle afferents on baroreflex control of the sinus node during exercise are unclear. We used a dobutamine infusion to induce hemodynamic changes comparable to those of moderate physical exercise in the absence of changes in central command and muscle afferents in 13 healthy subjects. Dobutamine (up to 9 g/kg body weight per minute) increased systolic blood pressure, shortened the RR interval, increased systolic blood pressure variability, but blunted RR interval variability (PϽ0.05 versus placebo). Consequently, dobutamine decreased the coherence between variations in systolic blood pressure and RR interval and decreased arterial baroreflex sensitivity from 12Ϯ2 to 3Ϯ1 ms/mm Hg (PϽ0.01). The largest increases in systolic blood pressure with dobutamine were paralleled by the greatest impairments in arterial baroreflex sensitivity (0.50ϽrϽ0.56, PϽ0.01). The chronotropic effects of dobutamine prevented a reflex bradycardia in response to the blood pressure increase. However, less predominant low-frequency oscillations in systolic blood pressure (PϽ0.0001) suggested preserved sympathetic withdrawal in response to the blood pressure increase induced by dobutamine. In conclusion, this study revealed that a shift in the operating point of the arterial baroreceptors and the chronotropic effects of adrenergic stimulation impair baroreflex control of the sinus node during dobutamine exercise stress testing. Baroreflex control of the sinus node is not reset when hemodynamic characteristics of exercise are reproduced in the absence of modifications in central command and muscles afferents. (Hypertension. 1999;33:987-991.)

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Value of SvO2 in Sepsis

Boulain¹,

Teboul²

The Sepsis Text

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Autonomic control of the heart and peripheral vessels in human septic shock

Abstract: Reduced LF components of the variability of cardiovascular signals are characteristic of septic shock, confirming the presence of abnormal autonomic control. Restored sympathetic (LF) modulation seems to be associated with a favourable prognosis.

Cited by 88 publications

References 29 publications

Heart Rate Variability in Emergency Department Patients with Sepsis

Heart Rate Variability in Emergency Department Patients with Sepsis

Arterial Baroreflex Control of the Sinus Node During Dobutamine Exercise Stress Testing

Value of SvO2 in Sepsis

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