Characteristics of Heart Rate Variability Can Predict Impending Septic Shock in Emergency Department Patients with Sepsis

Abstract

Objectives: To determine whether heart rate variability (HRV) measures can be used to predict which septic patients in the emergency department (ED) will progress to septic shock.Methods: The authors prospectively enrolled consecutive patients who met the 2001 International Sepsis Definitions Conference criteria of sepsis and visited the ED of a university teaching hospital over a sixmonth period. In addition to the septic workup, a continuous 10-minute electrocardiogram recording was performed at the same time. The HRV measures were calculated off-line and correlated with the outcome of the patients.Results: Eighty-one patients aged 30-84 years who met the inclusion criteria were enrolled. The patients were classified as those with no septic shock (n = 60) and those with septic shock (n = 21), according to their outcome within six hours. The baseline root mean square successive difference, high-frequency power, and normalized high-frequency power of the septic shock group were significantly higher than those of the no septic shock group. The low-frequency power, normalized low-frequency power, and low-/high-frequency power ratio of the septic shock group were significantly lower than those of the no septic shock group. Multiple logistic regression analysis identified root mean square successive difference as the best predictor of impending septic shock for septic ED patients.Conclusions: HRV measures may be used to identify septic ED patients with impending septic shock. Among those HRV measures, root mean square successive difference seems to be the best indicator to predict the occurrence of septic shock.

Estudio ECAIS: eventos cardiovasculares adversos inadvertidos en sepsis

“…En sepsis, esta descrito que hay pérdida de la variabilidad de la frecuencia cardiaca y este fenómeno se asocia a desenlaces desfavorables 36 . Esta es la primera serie con 100 pacientes, donde se demuestra pérdida de la variabilidad de la frecuencia cardiaca (VFC) evaluada por los índices estadísticos, SDNN y PNN50, los cuales se asocian a hiperactividad simpática y a pérdida del control parasimpático, respectivamente, fenó-meno encontrado en la cardiomiopatía séptica 35 .…”

Are there new approaches for diagnosis, therapy guidance and outcome prediction of sepsis?

“…In adult bone marrow transplant patients, alterations in HRV could be detected prior to the clinical diagnosis of sepsis [147] . Furthermore, in a prospective, observational study, initial detection of HRV changes in septic patients via electrocardiogram in the emergency department showed to be valuable in predicting inhospital mortality [148] . However, since changes in cardiac function also depend on various cofactors, further research is needed to elucidate the role of HRV assessment in diagnosis and outcome prediction in patients with suspected sepsis.…”

Caracterización matemática de dinámicas cardiacas neonatales normales a partir de la teoría de la probabilidad

“…Uno de los parámetros de evaluación de la dinámica cardiaca más utilizados en cardiología es la variabilidad de la frecuencia cardiaca (VFC) [27,28,29,30,31,32,33,34,35,36]. La disminución de su valor se ha asociado a enfermedad [27], tanto para la dinámica cardiaca adulta como para la neonatal [37,38,39,40].…”