scholarly journals Heart Rate Complexity in US Army Forward Surgical Teams During Pre Deployment Training

2019 ◽  
Vol 185 (5-6) ◽  
pp. e724-e733
Author(s):  
Michelle B Mulder ◽  
Matthew S Sussman ◽  
Sarah A Eidelson ◽  
Kirby R Gross ◽  
Mark D Buzzelli ◽  
...  
Keyword(s):  
Heart Rate ◽  
Physical Exercise ◽  
Health Care Systems ◽  
Mass Casualty ◽  
Future Health ◽  
Us Army ◽  
Non Invasive ◽  
Postural Changes ◽  
Surgical Teams ◽  
Heart Rate Complexity

Abstract Introduction For trauma triage, the US Army has developed a portable heart rate complexity (HRC) monitor, which estimates cardiac autonomic input and the activity of the hypothalamic-pituitary-adrenal (HPA) axis. We hypothesize that autonomic/HPA stress associated with predeployment training in U.S. Army Forward Surgical Teams will cause changes in HRC. Materials and Methods A prospective observational study was conducted in 80 soldiers and 10 civilians at the U.S. Army Trauma Training Detachment. Heart rate (HR, b/min), cardiac output (CO, L/min), HR variability (HRV, ms), and HRC (Sample Entropy, unitless), were measured using a portable non-invasive hemodynamic monitor during postural changes, a mass casualty (MASCAL) situational training exercise (STX) using live tissue, a mock trauma (MT) STX using moulaged humans, and/or physical exercise. Results Baseline HR, CO, HRV, and HRC averaged 72 ± 11b/min, 5.6 ± 1.2 L/min, 48 ± 24 ms, and 1.9 ± 0.5 (unitless), respectively. Supine to sitting to standing caused minimal changes. Before the MASCAL or MT, HR and CO both increased to ~125% baseline, whereas HRV and HRC both decreased to ~75% baseline. Those values all changed an additional ~5% during the MASCAL, but an additional 10 to 30% during the MT. With physical exercise, HR and CO increased to >200% baseline, while HRV and HRC both decreased to 40 to 60% baseline; these changes were comparable to those caused by the MT. All the changes were P < 0.05. Conclusions Various forms of HPA stress during Forward Surgical Team STXs can be objectively quantitated continuously in real time with a portable non-invasive monitor. Differences from resting baseline indicate stress anticipating an impending STX whereas differences between average and peak responses indicate the relative stress between STXs. Monitoring HRC could prove useful to field commanders to rapidly and objectively assess the readiness status of troops during STXs or repeated operational missions. In the future, health care systems and regulatory bodies will likely be held accountable for stress in their trainees and/or obliged to develop wellness options and standardize efforts to ameliorate burnout, so HRC metrics might have a role, as well.

Heart Rate Complexity in US Army Forward Surgical Teams During Pre-Deployment Training

2019 ◽  
Vol 229 (4) ◽  
pp. S188
Author(s):  
Michelle B. Mulder ◽  
Matthew S. Sussman ◽  
Sarah A. Eidelson ◽  
Kirby R. Gross ◽  
Mark D. Buzzelli ◽  
...  
Keyword(s):  
Heart Rate ◽  
Us Army ◽  
Surgical Teams ◽  
Heart Rate Complexity

Predeployment Mass Casualty and Clinical Trauma Training for US Army Forward Surgical Teams

2010 ◽  
Vol 21 (4) ◽  
pp. 982-986 ◽  
Author(s):  
Bruno M. T. Pereira ◽  
Mark L. Ryan ◽  
Michael P. Ogilvie ◽  
Juan Carlos Gomez-Rodriguez ◽  
Patrick McAndrew ◽  
...  
Keyword(s):  
Mass Casualty ◽  
Trauma Training ◽  
Us Army ◽  
Surgical Teams

Exercise-Induced Changes in Compensatory Reserve and Heart Rate Complexity

2019 ◽  
Vol 90 (12) ◽  
pp. 1009-1015 ◽  
Author(s):  
Michelle B. Mulder ◽  
Sarah A. Eidelson ◽  
Mark D. Buzzelli ◽  
Kirby R. Gross ◽  
Andriy I. Batchinsky ◽  
...  
Keyword(s):  
Heart Rate ◽  
Physical Exercise ◽  
Human Performance ◽  
Sample Entropy ◽  
Mean Square ◽  
Compensatory Reserve ◽  
Exercise Induced ◽  
Heart Rate Complexity ◽  
Combat Casualties ◽  
Induced Changes

BACKGROUND: Portable noninvasive Heart Rate Complexity (HRC) and Compensatory Reserve Measurement (CRM) monitors have been developed to triage supine combat casualties. Neither monitor has been tested in upright individuals during physical exercise. This study tests the hypothesis that exercise evokes proportional changes in HRC and CRM.METHODS: Two instruments monitored volunteers (9 civilian and 11 soldiers) from the Army Trauma Training Department (ATTD) before, during, and following physical exercise. One recorded heart rate (HR, bpm), cardiac output (CO, L · min−1), heart rate variability (HRV, root mean square of successive differences, ms), and HRC (Sample Entropy, unitless). The other recorded HR, pulse oximetry (Spo2, %), and CRM (%).RESULTS: Baseline HR, CO, HRV, HRC, and CRM averaged 72 ± 1 bpm, 5.6 ± 1.2 L · min−1, 48 ± 24 ms, 1.9 ± 0.5, and 85 ± 10% in seated individuals. Exercise evoked peak HR and CO at > 200% of baseline, while HRC and CRM were simultaneously decreased to minimums that were ≤ 50% of baseline (all P < 0.001). HRV changes were variable and unreliable. Spo2 remained consistently above 95%. During a 60 min recovery, HR and CRM returned to baseline on parallel tracks (t1/2=11 ± 8 and 18 ± 14 min), whereas HRC recovery was slower than either CRM or HR (t1/2=40 ± 18 min, both P < 0.05).DISCUSSION: Exercise evoked qualitatively similar changes in CRM and HRC. CRM recovered incrementally faster than HRC, suggesting that vasodilation, muscle pump, and respiration compensate faster than cardiac autonomic control in young, healthy volunteers. Both HRC and CRM appear to provide reliable, objective, and noninvasive metrics of human performance in upright exercising individuals.Mulder MB, Eidelson SA, Buzzelli MD, Gross KR, Batchinsky AI, Convertino VA, Schulman CI, Namias N, Proctor KG. Exercise-induced changes in compensatory reserve and heart rate complexity. Aerosp Med Hum Perform. 2019; 90(12):1009–1015.

US Army split forward surgical team management of mass casualty events in Afghanistan: Surgeon performed triage results in excellent outcomes

2009 ◽  
Vol 4 (6) ◽  
pp. 321-329 ◽  
Author(s):  
Shawn C. Nessen, DO, FACS ◽  
Daniel R. Cronk, MD ◽  
Jason Edens, MD ◽  
Brian J. Eastridge, MD, FACS ◽  
Lorne H. Blackbourne, MD, FACS
Keyword(s):  
Injury Severity ◽  
Surgical Care ◽  
Injured Patient ◽  
Mass Casualty ◽  
Trauma Patients ◽  
Us Army ◽  
Institutional Review ◽  
Mass Casualty Events ◽  
Admission Data ◽  
Surgical Teams

Objective: US Army “split” forward surgical teams (FST) currently provide most of the resuscitative surgical care for combat patients in Afghanistan. These small units typically comprised 10 personnel and two surgeons each, who frequently encounter mass casualty (MASCAL) situations in geographically isolated regions. This article evaluates the effectiveness of one split FST managing 43 MASCAL situations in two separate locations for more than a 14-month period in Afghanistan.Design: An Institutional Review Board-approved review of all admission data of the 541st FST was conducted. Comparison was made between patients treated in MASCAL situations to those of patients treated in non-MASCAL events.Setting: Split-based US Army forward surgical elements in a combat environment in Afghanistan.Patients: Two hundred eighty-two patients were treated during MASCAL events and 479 in non- MASCAL situations.Main Outcome Measures: The primary endpoint was survival outcomes among trauma patients when 5 or more patients arrived simultaneously or if 3 or more patients required immediate surgery.Results: Four patients (1.70 percent) died in the MASCAL group compared with 12 (3.30 percent) in the non-MASCAL group.The mortality of patients receiving surgery at the FST was 2.73 percent and the mortality was 0.93 percent in those transferred without surgery. In the MASCAL group, 41 patients (14.5 percent) were critically injured and the critical mortality rate was 6.25 percent. In MASCAL events, 39 percent of patients required surgery compared with 44.9 percent in the non- MASCAL group. The average Injury Severity Score (ISS) of the most severely injured patient was 21.19 and ISS rapidly decreased to scores consistent with mild injury suggesting over triage at the scene.Conclusions: Despite very limited resources, the split FST can achieve, with appropriate triage, acceptable mortality outcomes in MASCAL situations. Over triage at the wounding scene is common and surgical intervention is frequently required.

Relationship between Invasive and Non-Invasive Hemodynamic Measures in Experimental Pulmonary Hypertension

2020 ◽  
Vol 16 (1) ◽  
pp. 47-53
Author(s):  
Vicente Benavides-Córdoba ◽  
Mauricio Palacios Gómez
Keyword(s):  
Heart Rate ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Correlation Coefficient ◽  
Pearson Correlation ◽  
Systolic Pressure ◽  
Control Group ◽  
Pearson Correlation Coefficient ◽  
Non Invasive

Introduction: Animal models have been used to understand the pathophysiology of pulmonary hypertension, to describe the mechanisms of action and to evaluate promising active ingredients. The monocrotaline-induced pulmonary hypertension model is the most used animal model. In this model, invasive and non-invasive hemodynamic variables that resemble human measurements have been used. Aim: To define if non-invasive variables can predict hemodynamic measures in the monocrotaline-induced pulmonary hypertension model. Materials and Methods: Twenty 6-week old male Wistar rats weighing between 250-300g from the bioterium of the Universidad del Valle (Cali - Colombia) were used in order to establish that the relationships between invasive and non-invasive variables are sustained in different conditions (healthy, hypertrophy and treated). The animals were organized into three groups, a control group who was given 0.9% saline solution subcutaneously (sc), a group with pulmonary hypertension induced with a single subcutaneous dose of Monocrotaline 30 mg/kg, and a group with pulmonary hypertension with 30 mg/kg of monocrotaline treated with Sildenafil. Right ventricle ejection fraction, heart rate, right ventricle systolic pressure and the extent of hypertrophy were measured. The functional relation between any two variables was evaluated by the Pearson correlation coefficient. Results: It was found that all correlations were statistically significant (p <0.01). The strongest correlation was the inverse one between the RVEF and the Fulton index (r = -0.82). The Fulton index also had a strong correlation with the RVSP (r = 0.79). The Pearson correlation coefficient between the RVEF and the RVSP was -0.81, meaning that the higher the systolic pressure in the right ventricle, the lower the ejection fraction value. Heart rate was significantly correlated to the other three variables studied, although with relatively low correlation. Conclusion: The correlations obtained in this study indicate that the parameters evaluated in the research related to experimental pulmonary hypertension correlate adequately and that the measurements that are currently made are adequate and consistent with each other, that is, they have good predictive capacity.

Evaluation of Importance of Central Effects of Atenolol and Metoprolol Measured by Heart Rate Variability During Mental Performance Tasks, Physical Exercise, and Daily Life in Stable Postinfarct Patients

Circulation ◽  
1995 ◽  
Vol 92 (12) ◽  
pp. 3415-3423 ◽  
Author(s):  
Ype S. Tuininga ◽  
Harry J.G.M. Crijns ◽  
Jan Brouwer ◽  
Maarten P. van den Berg ◽  
Arie J. Man in’t Veld ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Physical Exercise ◽  
Daily Life ◽  
Mental Performance ◽  
Performance Tasks ◽  
Central Effects

scholarly journals Differential effects of the blood pressure state on pulse rate variability and heart rate variability in critically ill patients

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Elisa Mejía-Mejía ◽  
James M. May ◽  
Mohamed Elgendi ◽  
Panayiotis A. Kyriacou
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulse Rate ◽  
Pulse Transit Time ◽  
Pulse Rate Variability ◽  
Physiological Factors ◽  
Ecg Signals ◽  
Non Invasive ◽  
Electrocardiogram Ecg

AbstractHeart rate variability (HRV) utilizes the electrocardiogram (ECG) and has been widely studied as a non-invasive indicator of cardiac autonomic activity. Pulse rate variability (PRV) utilizes photoplethysmography (PPG) and recently has been used as a surrogate for HRV. Several studies have found that PRV is not entirely valid as an estimation of HRV and that several physiological factors, including the pulse transit time (PTT) and blood pressure (BP) changes, may affect PRV differently than HRV. This study aimed to assess the relationship between PRV and HRV under different BP states: hypotension, normotension, and hypertension. Using the MIMIC III database, 5 min segments of PPG and ECG signals were used to extract PRV and HRV, respectively. Several time-domain, frequency-domain, and nonlinear indices were obtained from these signals. Bland–Altman analysis, correlation analysis, and Friedman rank sum tests were used to compare HRV and PRV in each state, and PRV and HRV indices were compared among BP states using Kruskal–Wallis tests. The findings indicated that there were differences between PRV and HRV, especially in short-term and nonlinear indices, and although PRV and HRV were altered in a similar manner when there was a change in BP, PRV seemed to be more sensitive to these changes.

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