scholarly journals The Cardiac R-R Variation and Sympathetic Skin Response in the Intensive Care Unit

2007 ◽  
Vol 34 (3) ◽  
pp. 313-315 ◽  
Author(s):  
Charles Bolton ◽  
Jillian Thompson ◽  
Linda Bernardi ◽  
Christopher Voll ◽  
Bryan Young
Keyword(s):  
Intensive Care Unit ◽  
Nervous System ◽  
Intensive Care ◽  
Autonomic Nervous System ◽  
Neurological Disorders ◽  
Sympathetic Skin Response ◽  
Assisted Ventilation ◽  
Icu Patients ◽  
Autonomic Nervous ◽  
Skin Response

Background and Purpose:The central and peripheral nervous systems are often affected in intensive care unit (ICU) patients, especially those with prolonged assisted ventilation and sepsis or systemic inflammatory response syndrome (SIRS). The autonomic nervous system, however, has been under-investigated in such patients. We evaluated autonomic nervous system (ANS) function in 29 ICU patients with various neurological disorders.Methods:Testing involved cardiac R-R variation (CRRV) as an index of parasympathetic function and the sympathetic skin response (SSR) for sympathetic assessment.Results:Only those 8 patients with sepsis-related neuropathy or encephalopathy had abnormal CRRV, while the SSR was absent in all but 2 patients.Conclusions:Our preliminary study revealed a high incidence of autonomic dysfunction in ICU patients with various neurological disorders.

scholarly journals High rate of autonomic neuropathy in Cornelia de Lange Syndrome

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
M. J. Pablo ◽  
P. Pamplona ◽  
M. Haddad ◽  
I. Benavente ◽  
A. Latorre-Pellicer ◽  
...  
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Sensory Nerve ◽  
Sympathetic Skin Response ◽  
Premature Aging ◽  
High Rate ◽  
Cornelia De Lange Syndrome ◽  
Autonomic Nervous ◽  
Skin Response ◽  
Cornelia De Lange

Abstract Background Cornelia de Lange Syndrome (CdLS) is a rare congenital disorder characterized by typical facial features, growth failure, limb abnormalities, and gastroesophageal dysfunction that may be caused by mutations in several genes that disrupt gene regulation early in development. Symptoms in individuals with CdLS suggest that the peripheral nervous system (PNS) is involved, yet there is little direct evidence. Method Somatic nervous system was evaluated by conventional motor and sensory nerve conduction studies and autonomic nervous system by heart rate variability, sympathetic skin response and sudomotor testing. CdLS Clinical Score and genetic studies were also obtained. Results Sympathetic skin response and sudomotor test were pathological in 35% and 34% of the individuals with CdLS, respectively. Nevertheless, normal values in large fiber nerve function studies. Conclusions Autonomic nervous system (ANS) dysfunction is found in many individuals with Cornelia de Lange Syndrome, and could be related to premature aging.

scholarly journals Noninvasive measurements to evaluate the effects of military training on the human autonomic nervous system

2014 ◽  
Vol 8 (4) ◽  
pp. 453-461 ◽  
Author(s):  
Ji-Hong Chen ◽  
Qian Zhang ◽  
Xin Liu ◽  
Zhixin Li ◽  
Cuizhen Zhang ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Military Training ◽  
Low Frequency ◽  
Sympathetic Skin Response ◽  
Pacemaker Activity ◽  
Autonomic Nervous ◽  
Skin Response

AbstractBackground: Chinese university freshmen receive 4-weeks military training that involved moderate to intense physical exercise. Studies have demonstrated heterogeneous effects of exercise on the autonomic nervous system.Objective: To evaluate the effects of training on the autonomic nervous system noninvasively using electrogastrograms, heart rate variability (HRV), pulse rate, and the sympathetic skin response (SSR).Methods: Twenty freshmen received all assessments in the fasting state and after a standard meal: (1) one week before the training, (2) at the end of the second week of the training, and (3) one week after the training.Results: (1) The training had a significant effect on meal-induced gastric pacemaker activity. Before the training, a standard meal did not increase the dominant frequency of gastric slow waves, but the frequency increased during and after the training; (2) The preprandial high frequency (HF), low frequency (LF), and very low frequency (VLF) components of heart rate variability decreased significantly after the training. The ratio of the LF and HF (LF/HF) of the heart rate variability (HRV) did not significantly change after a meal or training condition. The basal pulse rate did not change. The latencies of the sympathetic skin response (SSR), as measured in the arm muscle, increased in response to the training.Conclusion: Military training affects meal-induced changes in gastric pacemaker activity, causes a marked reduction of the vagal tone to the heart with maintenance of the vagal-sympathetic balance, and its effects on SSR may reflect a reduction in sympathetic tone.

scholarly journals Case report: Perioperative management of a patient with familial dysautonomia

2021 ◽  
Vol 6 (2) ◽  
pp. 029-032
Author(s):  
Sarebanha Melodie ◽  
Valente Laura ◽  
Kalra Minnea ◽  
Joseph Layon A ◽  
Crimi Ettore
Keyword(s):  
Intensive Care Unit ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Crisis Management ◽  
Autosomal Recessive ◽  
Perioperative Management ◽  
Hemodynamic Instability ◽  
Familial Dysautonomia ◽  
Autonomic Nervous ◽  
Noxious Stimuli

Familial dysautonomia is a rare autosomal recessive neurodegenerative disease affecting cells of the autonomic nervous system. Patients with this disease are insensitive to pain but their autonomic nervous system is still activated with noxious stimuli. This report details a case of a patient with familial dysautonomia who underwent right ankle open reduction and internal fixation for a bimalleolar right ankle fracture. The patients preoperative and intraoperative course were uneventful but shortly after handoff to the intensive care unit, the patient experienced an autonomic crisis. Management of these patients is complex, requiring maintenance of physiologic homeostasis as well as preventing hemodynamic instability caused by noxious stimuli. Any deviations from baseline may cause an autonomic crisis, as happened in our patient. Herein, we detail the perioperative management of a patient with familial dysautonomia in further detail.

scholarly journals Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial

2018 ◽  
Vol 3 ◽  
pp. 58
Author(s):  
Huỳnh Thị Loan ◽  
Lam Minh Yen ◽  
Evelyne Kestelyn: ◽  
Nguyen Van Hao ◽  
Tran Tan Thanh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Nervous System ◽  
Intensive Care ◽  
Autonomic Nervous System ◽  
Intensive Care Unit Stay ◽  
Autonomic Nervous System Dysfunction ◽  
Tetanus Antitoxin ◽  
Randomized Controlled ◽  
Hospital Intensive Care Unit

Despite long-standing availability of an effective vaccine, tetanus remains a significant problem in many countries. Outcome depends on access to mechanical ventilation and intensive care facilities and in settings where these are limited, mortality remains high. Administration of tetanus antitoxin by the intramuscular route is recommended treatment for tetanus, but as the tetanus toxin acts within the central nervous system, it has been suggested that intrathecal administration of antitoxin may be beneficial. Previous studies have indicated benefit, but with the exception of one small trial no blinded studies have been performed. The objective of this study is to establish whether the addition of intrathecal tetanus antitoxin reduces the need for mechanical ventilation in patients with tetanus. Secondary objectives: to determine whether the addition of intrathecal tetanus antitoxin reduces autonomic nervous system dysfunction and length of hospital/ intensive care unit stay; whether the addition of intrathecal tetanus antitoxin in the treatment of tetanus is safe and cost-effective; to provide data to inform recommendation of human rather than equine antitoxin. This study will enroll adult patients (≥16 years old) with tetanus admitted to the Hospital for Tropical Diseases, Ho Chi Minh City. The study is a 2x2 factorial blinded randomized controlled trial. Eligible patients will be randomized in a 1:1:1:1 manner to the four treatment arms (intrathecal treatment and human intramuscular treatment, intrathecal treatment and equine intramuscular treatment, sham procedure and human intramuscular treatment, sham procedure and equine intramuscular treatment). Primary outcome measure will be requirement for mechanical ventilation. Secondary outcome measures: duration of hospital/ intensive care unit stay, duration of mechanical ventilation, in-hospital and 240-day mortality and disability, new antibiotic prescription, incidence of ventilator associated pneumonia and autonomic nervous system dysfunction, total dose of benzodiazepines and pipecuronium, and incidence of adverse events. Trial registration: ClinicalTrials.gov NCT02999815 Registration date: 21 December 2016

Prevalence of autonomic nervous system dysfunction in complex regional pain syndrome

2021 ◽  
pp. rapm-2020-101644
Author(s):  
Ho-Jin Lee ◽  
Kang Hee Lee ◽  
Jee Youn Moon ◽  
Yong-Chul Kim
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Sympathetic Skin Response ◽  
Binary Logistic Regression Analysis ◽  
Nerve Blocks ◽  
Autonomic Nervous System Dysfunction ◽  
Clinical Criteria ◽  
Autonomic Nervous

BackgroundWe aimed to investigate the prevalence of dysautonomia in complex regional pain syndrome (CRPS) via the combined autonomic nervous system (ANS) function tests, including the deep breathing test (DBT), orthostatic test (OST) and sympathetic skin response (SSR).MethodWe retrospectively examined 263 patients who underwent the combined ANS tests to evaluate CRPS between August 2013 and December 2016. Based on the Budapest clinical criteria, patients were stratified into confirmed-CRPS or suspected-CRPS groups. We performed binary logistic regression analysis using the inverse probability of treatment weighting to investigate the association between the tests and CRPS. Sensitivity and specificity were calculated to assess the diagnostic performance of the ANS tests for CRPS. We compared the results of these tests between the outcomes of sympathetic nerve blocks (SNBs).ResultsAmong 247 patients, finally included in this study, 199 patients (80.6%) were diagnosed with CRPS. Abnormal results of overall or each ANS function test showed significant associations with CRPS, excluding OST (overall abnormality: OR 2.44, 95% CI 1.51 to 3.95; p<0.001; DBT: OR 2.57, 95% CI 1.23 to 5.38, p=0.013; OST: OR 1.88, 95% CI 0.92 to 3.84, p=0.085; SSR: OR 2.71, 95% CI 1.38 to 5.32, p=0.004). However, their prevalence in CRPS and their sensitivities for CRPS were low (overall abnormality: 26.1%; each test: <15%). No significant association existed between dysautonomia and SNB outcomes.ConclusionDysautonomia, as evaluated using the combined ANS tests, were observed in a small portion of patients with CRPS. The diagnostic performances of these tests for CRPS were inadequate for clinical purposes.

scholarly journals Serum neurofilament light chain as outcome marker for intensive care unit patients

2020 ◽  
Author(s):  
Anna Lena Fisse ◽  
Kalliopi Pitarokoili ◽  
David Leppert ◽  
Jeremias Motte ◽  
Xiomara Pedreiturria ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Central Nervous System ◽  
Nervous System ◽  
Intensive Care ◽  
Light Chain ◽  
Neurofilament Light Chain ◽  
Icu Patients ◽  
Neurofilament Light ◽  
The Central Nervous System

Abstract Objective Neurofilament light chain (NfL) in serum indicates neuro-axonal damage in diseases of the central and peripheral nervous system. Reliable markers to enable early estimation of clinical outcome of intensive care unit (ICU) patients are lacking. The aim of this study was to investigate, whether serum NfL levels are a possible biomarker for prediction of outcome of ICU patients. Methods Thirty five patients were prospectively examined from admission to ICU until discharge from the hospital or death. NfL levels were measured longitudinally by a Simoa assay. Results NfL was elevated in all ICU patients and reached its maximum at day 35 of ICU treatment. Outcome determined by modified Rankin Scale at the end of the follow-up period correlated with NfL level at admission, especially in the group of patients with impairment of the central nervous system (n = 25, r = 0.56, p = 0.02). Conclusion NfL could be used as a prognostic marker for outcome of ICU patients, especially in patients with impairment of the central nervous system.

scholarly journals Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial

2018 ◽  
Vol 3 ◽  
pp. 58 ◽  
Author(s):  
Huỳnh Thị Loan ◽  
Lam Minh Yen ◽  
Evelyne Kestelyn: ◽  
Nguyen Van Hao ◽  
Tran Tan Thanh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Nervous System ◽  
Intensive Care ◽  
Autonomic Nervous System ◽  
Intensive Care Unit Stay ◽  
Autonomic Nervous System Dysfunction ◽  
Tetanus Antitoxin ◽  
Randomized Controlled ◽  
Hospital Intensive Care Unit

Despite long-standing availability of an effective vaccine, tetanus remains a significant problem in many countries. Outcome depends on access to mechanical ventilation and intensive care facilities and in settings where these are limited, mortality remains high. Administration of tetanus antitoxin by the intramuscular route is recommended treatment for tetanus, but as the tetanus toxin acts within the central nervous system, it has been suggested that intrathecal administration of antitoxin may be beneficial. Previous studies have indicated benefit, but with the exception of one small trial no blinded studies have been performed. The objective of this study is to establish whether the addition of intrathecal tetanus antitoxin reduces the need for mechanical ventilation in patients with tetanus. Secondary objectives: to determine whether the addition of intrathecal tetanus antitoxin reduces autonomic nervous system dysfunction and length of hospital/ intensive care unit stay; whether the addition of intrathecal tetanus antitoxin in the treatment of tetanus is safe and cost-effective; to provide data to inform recommendation of human rather than equine antitoxin. This study will enroll adult patients (≥16 years old) with tetanus admitted to the Hospital for Tropical Diseases, Ho Chi Minh City. The study is a 2x2 factorial blinded randomized controlled trial. Eligible patients will be randomized in a 1:1:1:1 manner to the four treatment arms (intrathecal treatment and human intramuscular treatment, intrathecal treatment and equine intramuscular treatment, sham procedure and human intramuscular treatment, sham procedure and equine intramuscular treatment). Primary outcome measure will be requirement for mechanical ventilation. Secondary outcome measures: duration of hospital/ intensive care unit stay, duration of mechanical ventilation, in-hospital and 240-day mortality and disability, new antibiotic prescription, incidence of ventilator associated pneumonia and autonomic nervous system dysfunction, total dose of benzodiazepines and pipecuronium, and incidence of adverse events. Trial registration: ClinicalTrials.gov NCT02999815 Registration date: 21 December 2016

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