scholarly journals Is the heart rate variability monitoring using the analgesia nociception index a predictor of illness severity and mortality in critically ill patients with COVID-19? A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249128
Author(s):  
Cristian Aragón-Benedí ◽  
Pablo Oliver-Forniés ◽  
Felice Galluccio ◽  
Ece Yamak Altinpulluk ◽  
Tolga Ergonenc ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Pilot Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
High Frequency Component ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Limit Value

Introduction The analysis of heart rate variability (HRV) has proven to be an important tool for the management of autonomous nerve system in both surgical and critically ill patients. We conducted this study to show the different spectral frequency and time domain parameters of HRV as a prospective predictor for critically ill patients, and in particular for COVID-19 patients who are on mechanical ventilation. The hypothesis is that most severely ill COVID-19 patients have a depletion of the sympathetic nervous system and a predominance of parasympathetic activity reflecting the remaining compensatory anti-inflammatory response. Materials and methods A single-center, prospective, observational pilot study which included COVID-19 patients admitted to the Surgical Intensive Care Unit was conducted. The normalized high-frequency component (HFnu), i.e. ANIm, and the standard deviation of RR intervals (SDNN), i.e. Energy, were recorded using the analgesia nociception index monitor (ANI). To estimate the severity and mortality we used the SOFA score and the date of discharge or date of death. Results A total of fourteen patients were finally included in the study. ANIm were higher in the non-survivor group (p = 0.003) and were correlated with higher IL-6 levels (p = 0.020). Energy was inversely correlated with SOFA (p = 0.039) and fewer survival days (p = 0.046). A limit value at 80 of ANIm, predicted mortalities with a sensitivity of 100% and specificity of 85.7%. In the case of Energy, a limit value of 0.41 ms predicted mortality with all predictive values of 71.4%. Conclusion A low autonomic nervous system activity, i.e. low SDNN or Energy, and a predominance of the parasympathetic system, i.e. low HFnu or ANIm, due to the sympathetic depletion in COVID-19 patients are associated with a worse prognosis, higher mortality, and higher IL-6 levels.

scholarly journals Heart Rate Variability Using The Analgesia Nociception Index as A Predictor of Illness Severity and Mortality in Critically Ill Patients with COVID-19.

2020 ◽  
Author(s):  
Cristian Aragón-Benedí ◽  
Pablo Oliver-Forniés ◽  
Felice Galluccio ◽  
Ece Yamak Altinpulluk ◽  
Tolga Ergonenc ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
High Frequency ◽  
Frequency Component ◽  
High Frequency Component ◽  
Autonomic Nervous

Abstract Introduction A balance between the autonomic nervous system and the immune system against SARS-COV-2 is critical in the resolution of its severe macrophage proinflammatory activation. To demonstrate that most severely ill COVID-19 patients will show a depletion of the sympathetic nervous system and a predominance of parasympathetic tone. We hypothesized that a low energy of an autonomic nervous system and a high level of the high frequency component of heart rate variability may be related to the number of proinflammatory cytokines and could have a predictive value in terms of severity and mortality in critically ill patients suffering from COVID-19; Materials and Methods Single-centre, prospective, observational pilot study which included COVID-19 patients admitted to the Surgical Intensive Care Unit. High frequency (HF) component of heart rate variability (HRV) and energy of the autonomic nervous system were recorded using analgesia nociception index monitor (ANI). To estimate the severity and mortality we used the SOFA score and the date of discharge or date of death.Results A total of fourteen patients were finally included in the study. High-frequency component of heart rate variability (ANIm) were higher in the non-survivor group (p = 0.003) and were correlated with higher IL-6 levels (p = 0.002) Energy was inversely correlated with SOFA (p = 0.029). Limit value at 80 of ANIm, predicted mortalities with the sensitivity of 100% and specificity of 85.7%. In the case of energy, a limit value of 0.41 predicted mortality with all predictive values of 71.4%.Conclusion The different components of the spectral analysis of HRV allow us to infer the association between the autonomic nervous system and critically ill patients’ immune system. A low autonomic nervous system activity and a predominance of the parasympathetic system due to sympathetic depletion in patients are associated with a worse prognosis and higher mortality.

scholarly journals Measurement of the nociceptive flexion reflex threshold in critically ill patients – a randomized observational pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benedikt Schick ◽  
Benjamin Mayer ◽  
Steffen Walter ◽  
Sascha Gruss ◽  
Ronald Stitz ◽  
...  
Keyword(s):  
Pilot Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Flexion Reflex ◽  
Nociceptive Flexion Reflex ◽  
Reflex Threshold

Abstract Background Pain detection and treatment is a major challenge in the care of critically ill patients, rendered more complex by the need to take into consideration the risk of insufficient or excessive analgesia. The nociceptive flexion reflex threshold (NFRT) has become the established basis for measuring the level of analgesia in the perioperative context. However, it remains unclear whether NFRT measurement can be usefully applied to mechanically ventilated, analgosedated critically ill patients who are unable to communicate. Therefore, the aim of the present study was to investigate whether there is an association between the NFRT measurement and the Behavioral Pain Scale (BPS) in critically ill, analgosedated, and mechanically ventilated patients and whether the NFRT measurement can also detect potential excessive analgesia. Methods This prospective, observational, randomized single-center pilot study included patients admitted to the surgical Intensive Care Unit of University Hospital Ulm, Germany, all of whom were analgosedated and intubated. Major exclusion criteria were defined as the need for the administration of neuromuscular blocking agents or neurological diseases associated with peripheral nerve conduction restriction. Initial NFRT and BPS measurements were conducted within 12 h after admission. A structured pain assessment was performed at least twice daily until extubation throughout the observation period thereafter (Group A: BPS + NFRT, Group B: BPS). Results 114 patients were included in the study. NFRT is associated negatively with BPS. NFRT was almost twice as high in patients with a Richmond Agitation Sedation Scale (RASS) score of -5 than in patients with a RASS score ≥ -4 (RASS -5 – NFRT: 59.40 vs. RASS -4 – NFRT: 29.00, p < 0.001). Conclusions NFRT measurement is associated negatively with the BPS in critically ill patients. NFRT measurement provides guidance for the evaluation of nociceptive processes in patients with RASS scores ≤ −4, in whom analgesia level is often difficult to assess. However, in order to identify excessive analgesia and derive therapeutic consequences, it is necessary to gradually decrease analgesics and sedatives until a stimulus threshold is reached at which the patient does not feel pain. Trial Registration Retrospectively registered in the German Clinical Trials Register, registration number DRKS00021149, date of registration: March 26, 2020. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021149.

scholarly journals Correction: Is the heart rate variability monitoring using the analgesia nociception index a predictor of illness severity and mortality in critically ill patients with COVID-19? A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252259
Author(s):  
Cristian Aragón-Benedí ◽  
Pablo Oliver-Forniés ◽  
Felice Galluccio ◽  
Ece Yamak Altinpulluk ◽  
Tolga Ergonenc ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pilot Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Illness Severity

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

scholarly journals Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hanan Mostafa ◽  
Mohamed Shaban ◽  
Ahmed Hasanin ◽  
Hassan Mohamed ◽  
Shymaa Fathy ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pulmonary Oedema ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Perfusion Index ◽  
Intradialytic Hypotension ◽  
Peripheral Perfusion ◽  
Hemodialysis Session ◽  
Prophylactic Measures

Abstract Background Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Early prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension. Methods A prospective observational study included 36 critically ill patients with acute kidney injury during their first session of intermittent hemodialysis. In addition to basic vital signs, PPI was measured using Radical-7 (Masimo) device. Electrical cardiometry (ICON) device was used for measuring cardiac output, systemic vascular resistance, and HRV. All hemodynamic values were recorded at the following time points: 30 min before the hemodialysis session, 15 min before the start of hemodialysis session, every 5 min during the session, and 15 min after the conclusion of the session. The ability of all variables to predict intradialytic hypotension was assessed through area under receiver operating characteristic (AUROC) curve calculation. Results Twenty-three patients (64%) had intradialytic hypotension. Patients with pulmonary oedema showed higher risk for development of intradialytic hypotension {Odds ratio (95% CI): 13.75(1.4–136)}. Each of baseline HRV, and baseline PPI showed good predictive properties for intradialytic hypotension {AUROC (95% CI): 0.761(0.59–0.88)}, and 0.721(0.547–0.857)} respectively. Conclusions Each of low PPI, low HRV, and the presence of pulmonary oedema are good predictors of intradialytic hypotension.

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