Postresuscitation autonomic nervous modulation after cardiac arrest resembles that of severe sepsis

Chen, Wei-Lung; Shen, Ying-Sheng; Huang, Chien‐Cheng; Chen, Jiann-Hwa; Kuo, Cheng–Deng

doi:10.1016/j.ajem.2010.11.013

Cited by 18 publications

(18 citation statements)

References 36 publications

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“…Except for the study of Chen and cols. 2012[ 27 ], in which patients with sepsis were included as controls of successfully resuscitated patients with out-of-hospital cardiac arrest (the main population of interest in the study), all other studies were prospective cohorts primary designed to include/primary focused on septic patients. One of the studies[ 25 ] was a combined prospective cohort and case-control study.…”

Section: Resultsmentioning

confidence: 99%

“…The cohort group consisted of 33 septic patients, and these were the data we used in this review. Regarding the diagnostic criteria for sepsis used in each study, in two studies[ 28 , 30 ] this information is not clearly reported, while in the other 7 studies[ 18 , 24 – 27 , 29 , 31 ] the presence of infection and SIRS was used as the diagnostic criteria. Of these seven studies, two[ 24 , 31 ] use the 1992 Consensus[ 32 ], while five[ 18 , 25 – 27 , 29 ] use the 2001 consensus[ 33 ].…”

Section: Resultsmentioning

confidence: 99%

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Heart rate variability as predictor of mortality in sepsis: A systematic review

et al. 2018

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BackgroundAutonomic dysregulation is one of the recognized pathophysiological mechanisms in sepsis, generating the hypothesis that heart rate variability (HRV) can be used to predict mortality in sepsis.MethodsThis was a systematic review of studies evaluating HRV as a predictor of death in patients with sepsis. The search was performed by independent researchers in PubMed, LILACS and Cochrane, including papers in English, Portuguese or Spanish, indexed until August 20th, 2017 with at least 10 patients. Study quality was assessed by Newcastle-Ottawa Scale. To analyze the results, we divided the articles between those who measured HRV for short-term recordings (≤ 1 hour), and those who did long-term recordings (≥ 24 hours).ResultsNine studies were included with a total of 536 patients. All of them were observational studies. Studies quality varied from 4 to 7 stars in Newcastle-Ottawa Scale. The mortality rate in the studies ranged from 8 to 61%. Seven studies performed HRV analysis in short-term recordings. With the exception of one study that did not explain which group had the lowest results, all other studies showed reduction of several HRV parameters in the non-survivors in relation to the surviving septic patients. SDNN (Standard deviation of the Normal to Normal interval), TP (Total Power), VLF (Very Low Frequency Power), LF (Low Frequency Power), LF/HF (Low Frequency Power / High Frequency Power), nLF (Normalized Low Frequency Power), α1/α2 (short-term and long-term fractal scaling coefficients from DFA) and r-MSSD (Square root of the squared mean of the difference of successive NN-intervals) of the non-survivor group were reduced in relation to the survivors in at least one study. Two studies found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors. Three studies performed HRV analysis using long-term recordings. Only one of these studies found difference between surviving and non-surviving groups, and even so, in only one HRV parameter: LogHF.ConclusionsSeveral HRV parameters are reduced in nonsurviving septic patients in short-term recording. Two studies have found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Heart rate variability as predictor of mortality in sepsis: A systematic review

et al. 2018

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“…Similarly, Chen et al (2012) compared HRV metrics of resuscitated cardiac arrest patients, patients with sepsis and healthy controls. The raw LF and HF power of healthy controls ranged between approximately 12–100 times greater than all patient groups.…”

Section: Discussionmentioning

confidence: 99%

Everything Hertz: methodological issues in short-term frequency-domain HRV

2014

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Frequency analysis of the electrocardiographic RR interval is a common method of quantifying autonomic outflow by measuring the beat-to-beat modulation of the heart (heart rate variability; HRV). This review identifies a series of problems with the methods of doing so-the interpretation of low-frequency spectral power, the multiple use of equivalent normalized low frequency (LFnu), high frequency (HFnu) and ratio (LF/HF) terms, and the lack of control over extraneous variables, and reviews research in the calendar year 2012 to determine their prevalence and severity. Results support the mathematical equivalency of ratio units across studies, a reliance on those variables to explain autonomic outflow, and insufficient control of critical experimental variables. Research measurement of HRV has a substantial need for general methodological improvement.Keywords: heart rate variability, autonomic nervous system, sympatho-vagal balance, sympathetic nervous system, parasympathetic nervous system INTRODUCTIONHeart rate variability (HRV), the fluctuation of instantaneous heart period over time, is a correlate of cardiac autonomic regulation. HRV techniques have been applied in a broad range of contexts-they have been used to predict mortality after myocardial infarction (Buccelletti et al., 2009), as a correlate of stress (Berntson and Cacioppo, 2007) and psychopathology, to stratify attention (Mulder and Mulder, 1981), and have been incorporated into biobehavioral models of self-regulation (Porges, 1995;Thayer and Lane, 2000). The idea that reliable measurement of autonomic state may be obtained cheaply and non-invasively is obviously appealing. Figure 1 illustrates a growing interest in HRV methods over time, a trend which seem likely to continue given the increasing access to heart rate data through recent technological advances-heart rate has recently been accurately calculated via smartphone (Heathers, 2013), microwave (Suzuki et al., 2008) and induction-powered indwelling device (Riistama et al., 2007). Short recordings of HRV (i.e., less than 1 h) typically show two primary patterns of oscillation which are separated into frequency bands from ≈7 to 25 s (0.04-0.15 Hz; low frequency, or LF) and 2.5 to ≈7 s (0.15-0.4 Hz; high frequency, or HF)-lower frequencies than LF are generally not meaningful over the short term. LF and HF frequency bands are widely used to quantify parasympathetic and sympathetic regulation (Akselrod et al., 1981) and their interaction (Malliani et al., 1991).As ease of access to HRV increases, establishing and maintaining correct methodology is important-redundant methodology may delay treatment, obscure valuable underlying effects, provoke Type I or II errors, and most importantly, potentially delegitimize both alternative useful results and the utility of HRV in general.However, the internal and external consistency of the methods used have received comparatively less research interest than the understanding of the autonomic, cardiac and circulatory which creates those methods (Billman, 201...

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“…[1][2][3][4][5]19,21 Interestingly, reduction in HRV after cardiac arrest resembles the profile of severe sepsis in adults. 22 In newborns, depressed HRV after hypoxic ischemic encephalopathy is associated with adverse short term neurological outcomes (EEG and MRI) and death. 23 One intervention which might preserve HRV after cardiac arrest is hypothermia.…”

Section: Discussionmentioning

confidence: 99%