Real-time heart rate entropy predicts the need for lifesaving interventions in trauma activation patients

Abstract

Prognostic and diagnostic study, level III.

Autonomic impairment of patients in coma with different Glasgow coma score assessed with heart rate variability

“…Our results also confirm that the spectral HRV indices show a better prediction for mortality or other outcomes as others have noted [20]. seconds [14], 600 seconds [103], 200 consecutive beats [33,34,36], 800 consecutive heart beats [37], or not clearly specified [12,19,104]. Notwithstanding these methodological differences (and many others not detailed here) between studies, HRV indices have shown their efficiency to predict different outcomes in patients with brain injuries.…”

“…Reduced HRV has been previously observed and reported by us [13,15,16] and by many other authors that have investigated patients in coma with brain lesions of different etiologies [6, 7, 10-12, 14, 18, 21, 26]. Several studies have demonstrated the potential utility of HRV as an indicator of mortality in intensive care unit patients [24,25,[28][29][30][31][32], and also as an indicator of prediction of lifesaving interventions in patients with trauma [22,[33][34][35][36][37]. However, to our knowledge, this study is the first reporting this issue by applying a novel method for the analysis of HRV indices, the so called Hilbert-Huang method, that has been developed for the digital processing of signals that contain non-Gaussian, nonlinear or non-stationary processes, as is the case of the cardiac R-R tachograms, from which are derived the HRV indices [63,68,69,74,[91][92][93] Significant differences have been found of HRV indices between survivors and nonsurvivors in several studies.…”

“…In the current study those deleterious influences were avoided correspondingly. Third, another issue to be considered is the effect of nonlinear and non-stationary processes that have necessarily to be present in these critically ill patients [22,23,33], and that can be overcome using appropriate methods for the analysis of HRV indices, as those used in this study. Fourth and finally, the inclusion for the spectral analysis of HRV indices of the very high frequency range (0.4 -0.6 Hz), that has been not extensively studied, but that has shown evidences of pathophysiologic interest in the last years [70,71,[99][100][101].…”

“…It has been shown that the ANS functional state predicts responsiveness in disorders of consciousness [5]. Multiple indices of HRV calculated in the time, frequency or informational domains have been studied in patients in coma with different objectives: to assess brainstem dysfunction [6], to assess brain death [7][8][9], differentiation of autonomic nervous activity in different stages of coma [10], diagnosis of dysautonomia after traumatic brain injuries (TBI) [11], calculation and description of HRV indices of patients in coma [12] correlation of the HRV parameters with the Glasgow coma score (GCS) [13][14][15][16], prediction or prognosis of the outcome in TBI, acute cerebral vascular disease, or critically ill neurosurgical patients [17][18][19][20][21][22][23], association of HRV indices with mortality in patients with TBI [24][25][26][27][28][29][30][31][32], and prediction of life saving interventions in patients with trauma [22,[33][34][35][36][37].…”

Complexity of Wake Electroencephalography Correlates With Slow Wave Activity After Sleep Onset

“…According to the complexity theories, somewhat higher complexity is associated with relatively improved health conditions and greater chances of survival (Costa et al, 2002a , 2005 ), while a reduction in or loss of complexity is often associated with imbalance or disturbed physiological conditions, usually implying disease or aging (Goldberger et al, 2002 ). In many studies, complexity-based metrics of the dynamics of a physiological system have demonstrated better prognostic power (Mejaddam et al, 2013 ; Lin et al, 2014 ; Vandendriessche et al, 2014 ; Moshirvaziri et al, 2016 ; Chiu et al, 2017 ; Ma et al, 2017 ). The complexity theories also suggest that different levels of complexity can indicate whether a system is under stress or relatively relaxed (Costa et al, 2002a , 2005 ; Goldberger et al, 2002 ).…”