Monitoring Severity of Multiple Organ Dysfunction Syndrome: New Technologies

Typpo, Katri; Wong, Hector R.; Finley, Stacey D.; Daniels, Rodney C.; Seely, Andrew J. E.; Lacroix, Jacques

doi:10.1097/pcc.0000000000001050

Cited by 14 publications

(6 citation statements)

References 65 publications

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“…In the clinical arena, multiple aspects of disease etiology and outcomes exist, and as the technologies for understanding sepsis and MODS biomarkers have evolved, there is much space for developing tools that have potential to actually impact therapy (52). A typical cohort of PICU patients presenting MODS, as shown in this paper, is composed of a broad etiology of disease, including diverse environmental contributions and various infections.…”

Section: Discussionmentioning

confidence: 99%

Virus-induced genetics revealed by multidimensional precision medicine transcriptional workflow applicable to COVID-19

Prokop

Shankar

Gupta

et al. 2020

Physiological Genomics

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Precision medicine requires the translation of basic biological understanding to medical insights, mainly applied to characterization of each unique patient. In many clinical settings, this requires tools that can be broadly used to identify pathology and risks. Patients often present to the intensive care unit with broad phenotypes, including multiple organ dysfunction syndrome (MODS) resulting from infection, trauma, or other disease processes. Etiology and outcomes are unique to individuals, making it difficult to cohort patients with MODS, but presenting a prime target for testing/developing tools for precision medicine. Using multitime point whole blood (cellular/acellular) total transcriptomics in 27 patients, we highlight the promise of simultaneously mapping viral/bacterial load, cell composition, tissue damage biomarkers, balance between syndromic biology versus environmental response, and unique biological insights in each patient using a single platform measurement. Integration of a transcriptome workflow yielded unexpected insights into the complex interplay between host genetics and viral/bacterial specific mechanisms, highlighted by a unique case of virally induced genetics (VIG) within one of these 27 patients. The power of RNA-Seq to study unique patient biology while investigating environmental contributions can be a critical tool moving forward for translational sciences applied to precision medicine.

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Section: Discussionmentioning

confidence: 99%

Virus-induced genetics revealed by multidimensional precision medicine transcriptional workflow applicable to COVID-19

Prokop

Shankar

Gupta

et al. 2020

Physiological Genomics

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“…Furthermore, a recent review of new monitoring technologies for pediatric organ dysfunction highlights the challenges of using electrocardiographic data for estimating HRV. 7…”

Section: Discussionmentioning

confidence: 99%

“…This makes PRVi a highly accessible and available digital measure of clinical status, as opposed to other measures of HRV. 6,7 In addition, the down-sampling involved with the intermittent data needed for calculating PRVi makes it computationally more feasible and generalizable than calculating HRV using continuous waveforms.…”

Section: Discussionmentioning

confidence: 99%

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Using photoplethysmography data to estimate heart rate variability and its association with organ dysfunction in pediatric oncology patients

2018

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Pediatric oncology patients are at high risk of developing clinical deterioration and organ dysfunction during their illness. Heart rate variability (HRV) measured using electrocardiography waveforms is associated with increased organ dysfunction and clinical deterioration in adult and pediatric patients in the intensive care unit (ICU). Here, we explore the feasibility of using photoplethysmography (PPG)-derived integer pulse rate variability (PRVi) to estimate HRV and determine its association with organ dysfunction in pediatric oncology patients in the ward and pediatric ICU. The advantage of using PPG sensor data over electrocardiography is its higher availability in most healthcare settings and in wearable technology. In a cohort of 38 patients, reduced median daily PRVi was significantly associated with increase in two pediatric organ dysfunction scores after adjusting for confounders ( p < 0.001). PRVi shows promise as a real-time physiologic marker of clinical deterioration using highly-available PPG data, but further research is warranted.

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“…For example, using bedside HRV monitoring as a predictive tool of sepsis in premature neonates has been associated with decreased risk of mortality ( 19 , 50 – 52 ). The limited use of non-invasive monitoring of ANS function in the ICU is in part due to technological complexities, particularly in children, although the digitalization of the healthcare system is facilitating the implementation of the systems and algorithms necessary to do so ( 53 , 54 ). In addition, HRV varies with patient factors such as age, gender, medications, and mechanical ventilation, which creates challenges for its use and interpretation at the bedside.…”

Section: Autonomic Nervous System Dysfunction In Pediatric Sepsis: Cumentioning

confidence: 99%

Autonomic Nervous System Dysfunction in Pediatric Sepsis

et al. 2018

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The autonomic nervous system (ANS) plays a major role in maintaining homeostasis through key adaptive responses to stress, including severe infections and sepsis. The ANS-mediated processes most relevant during sepsis include regulation of cardiac output and vascular tone, control of breathing and airway resistance, inflammation and immune modulation, gastrointestinal motility and digestion, and regulation of body temperature. ANS dysfunction (ANSD) represents an imbalanced or maladaptive response to injury and is prevalent in pediatric sepsis. Most of the evidence on ANSD comes from studies of heart rate variability, which is a marker of ANS function and is inversely correlated with organ dysfunction and mortality. In addition, there is evidence that other measures of ANSD, such as respiratory rate variability, skin thermoregulation, and baroreflex and chemoreflex sensitivity, are associated with outcomes in critical illness. The relevance of understanding ANSD in the context of pediatric sepsis stems from the fact that it might play an important role in the pathophysiology of sepsis, is associated with outcomes, and can be measured continuously and noninvasively. Here we review the physiology and dysfunction of the ANS during critical illness, discuss methods for measuring ANS function in the intensive care unit, and review the diagnostic, prognostic, and therapeutic value of understanding ANSD in pediatric sepsis.

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Monitoring Severity of Multiple Organ Dysfunction Syndrome: New Technologies

Cited by 14 publications

References 65 publications

Virus-induced genetics revealed by multidimensional precision medicine transcriptional workflow applicable to COVID-19

Virus-induced genetics revealed by multidimensional precision medicine transcriptional workflow applicable to COVID-19

Using photoplethysmography data to estimate heart rate variability and its association with organ dysfunction in pediatric oncology patients

Autonomic Nervous System Dysfunction in Pediatric Sepsis

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