Heart Rate Variability in Emergency Department Patients with Sepsis

Barnaby, Douglas P.; Ferrick, Kevin J.; Kaplan, Daniel T.; Shah, Sachin; Bijur, Polly E.; Gallagher, E. John

doi:10.1111/j.1553-2712.2002.tb02143.x

Cited by 109 publications

(68 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It should be possible to determine whether these drugs modulate peripheral cytokine responses and vagus nerve activity in patients. Cholinergic and anticholinergic drugs are also widely used in intensive care units, where patients with sepsis and organ failure have increased cytokine levels and depressed vagus nerve activity (55,56,(81)(82)(83). It will be interesting to study whether commonly used cholinergic and anticholinergic drugs exert previously unrecognized effects on modulating cytokine responses, vagus nerve activity, and disease progression in this setting.…”

Section: Shedding Light On Ancient Concepts and Modern Clinical Problemsmentioning

confidence: 99%

“…Sudden death, increased morbidity and mortality following cardiac surgery in hostile or depressed patients, and increased death rates in patients with sepsis or organ failure are linked clinically to decreased vagus nerve activity (50)(51)(52)(53)(54). Clinical research implicates a significant correlation between depressed vagus nerve activity and increased morbidity and mortality in sepsis, rheumatoid arthritis, lupus, sarcoidosis, inflammatory bowel diseases, other diseases, and trauma (55)(56)(57)(58)(59)(60)(61)(62)(63). These studies demonstrate that decreased vagus nerve activity is associated with increased disease severity, but they have not established a causal relationship.…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Physiology and immunology of the cholinergic antiinflammatory pathway

Tracey¹

2007

J. Clin. Invest.

1,388

1,131

View full text Add to dashboard Cite

Cytokine production by the immune system contributes importantly to both health and disease. The nervous system, via an inflammatory reflex of the vagus nerve, can inhibit cytokine release and thereby prevent tissue injury and death. The efferent neural signaling pathway is termed the cholinergic antiinflammatory pathway. Cholinergic agonists inhibit cytokine synthesis and protect against cytokine-mediated diseases. Stimulation of the vagus nerve prevents the damaging effects of cytokine release in experimental sepsis, endotoxemia, ischemia/reperfusion injury, hemorrhagic shock, arthritis, and other inflammatory syndromes. Herein is a review of this physiological, functional anatomical mechanism for neurological regulation of cytokine-dependent disease that begins to define an immunological homunculus.

show abstract

Section: Shedding Light On Ancient Concepts and Modern Clinical Problemsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Physiology and immunology of the cholinergic antiinflammatory pathway

Tracey¹

2007

J. Clin. Invest.

1,388

1,131

View full text Add to dashboard Cite

show abstract

“…Measurement of the "heart rate variability" (HRV) is a promising technique to evaluate the autonomic cardiac regulation in patients with suspected sepsis. Although underlying mechanisms are still unclear, changes in HRV are associated with the appearance of systemic infections [144] and correlate with disease severity [145,146] . The measurement of HRV may be a promising tool to improve an early diagnosis of sepsis.…”

Section: Heart Rate Variabilitymentioning

confidence: 99%

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

Kojic

Siegler

Uhle

et al. 2015

WJEM

View full text Add to dashboard Cite

Beside many efforts to improve outcome, sepsis is still one of the most frequent causes of death in critically ill patients. It is the most common condition with high mortality in intensive care units. The complexity of the septic syndrome comprises immunological aspects -i.e. , sepsis induced immunosuppression -but is not restricted to this fact in modern concepts. So far, exact mechanisms and variables determining outcome and mortality stay unclear. Since there is no typical risk profile, early diagnosis and risk stratification remain difficult, which hinders rapid and effective treatment initiation. Due to the heterogeneous nature of sepsis, potential therapy options should be adapted to the individual. Biomarkers like C-reactive protein and procalcitonin are routinely used as complementary tools in clinical decision-making. Beyond the acute phase proteins, a wide bunch of promising substances and non-laboratory tools with potential diagnostic and prognostic value is under intensive investigation. So far, clinical decision just based on biomarker assessment is not yet feasible. However, biomarkers should be considered as a complementary approach. Core tip: Sepsis is a complex continuum of disturbed systems. Despite the presence of clinical consensus criteria, the early diagnosis especially in the perioperative setting is challenging. A magnitude of potential new biomarkers is tested for this purpose, but evidence is mounting that due to the complex nature of the syndrome, biomarkers are rather complementary tools for clinical decision making than "magic bullets". Moreover, biomarkers are also evaluated for therapy guidance, linking diagnostic results to an individual therapeutic regime. This review summarizes the developments in the biomarker field, aiming to provide an overview about current targets and their limitations.

show abstract

“…bei chirurgischen Patienten mit einem besseren Überle-ben assoziiert, besonders wenn sie über einen insgesamt niedrigen autonomen Tonus verfügten [59]. Weiterhin stellte eine LF/HF-Ratio < 1 bei schwerer Sepsis einen besonderen Risikofaktor für das Versterben dar [60].…”

Section: Ergebnisseunclassified

Beeinträchtigung des kardialen autonomen Nervensystems und Arrhythmie-Inzidenz bei schwerer Hyperglykämie

2010

View full text Add to dashboard Cite

Clinical complications in high glucose levels must be seen in the context of a nearly complete blockade of sympathetic and parasympathetic activity. Basically to extreme autonomic restriction, sympathetic and vagal predominance can change rapidly into each other. This retarded vulnerable predisposition may declare the arrhythmic potential. An important progress in the monitoring of patients could be achieved by implementation of a continuous HRV measurement because hereby the actual risk potential can be ascertained timely and reliably.

show abstract

Heart Rate Variability in Emergency Department Patients with Sepsis

Cited by 109 publications

References 36 publications

Physiology and immunology of the cholinergic antiinflammatory pathway

Physiology and immunology of the cholinergic antiinflammatory pathway

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

Beeinträchtigung des kardialen autonomen Nervensystems und Arrhythmie-Inzidenz bei schwerer Hyperglykämie

Contact Info

Product

Resources

About