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

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.

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Prediction of cardiac arrest in critically ill patients presenting to the emergency department using a machine learning score incorporating heart rate variability compared with the modified early warning score

Critical Care ◽

10.1186/cc11396 ◽

2012 ◽

Vol 16 (3) ◽

pp. R108 ◽

Cited By ~ 44

Author(s):

Marcus Eng Hock Ong ◽

Christina Hui Lee Ng ◽

Ken Goh ◽

Nan Liu ◽

Zhi Koh ◽

...

Keyword(s):

Machine Learning ◽

Emergency Department ◽

Heart Rate ◽

Heart Rate Variability ◽

Cardiac Arrest ◽

Critically Ill ◽

Early Warning ◽

Critically Ill Patients ◽

Early Warning Score ◽

Learning Score

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

BMC Anesthesiology ◽

10.1186/s12871-019-0917-1 ◽

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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Electrocardiomatrix facilitates qualitative identification of diminished heart rate variability in critically ill patients shortly before cardiac arrest

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2018.08.006 ◽

2018 ◽

Vol 51 (6) ◽

pp. 955-961 ◽

Cited By ~ 1

Author(s):

Gang Xu ◽

Sneha Dodaballapur ◽

Temenuzhka Mihaylova ◽

Jimo Borjigin

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Cardiac Arrest ◽

Critically Ill ◽

Critically Ill Patients

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Heart Rate Variability: Utility in Critically Ill Patients?

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a1772 ◽

2020 ◽

Author(s):

G.L. Jones ◽

V. Patel ◽

A. Achunair ◽

D.J. Patel ◽

J. Chiong ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Critically Ill ◽

Critically Ill Patients

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The Effects of Brain Injury on Heart Rate Variability and the Innate Immune Response in Critically Ill Patients

Journal of Neurotrauma ◽

10.1089/neu.2011.2035 ◽

2012 ◽

Vol 29 (5) ◽

pp. 747-755 ◽

Cited By ~ 32

Author(s):

Matthijs Kox ◽

Maarten Q. Vrouwenvelder ◽

Jan C. Pompe ◽

Johannes G. van der Hoeven ◽

Peter Pickkers ◽

...

Keyword(s):

Heart Rate ◽

Immune Response ◽

Heart Rate Variability ◽

Brain Injury ◽

Critically Ill ◽

Innate Immune Response ◽

Critically Ill Patients ◽

Innate Immune

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

10.21203/rs.2.9492/v2 ◽

2019 ◽

Author(s):

Mohamed Shaban ◽

Ahmed Hasanin ◽

Akram El-adawy ◽

Hanan Mostafa ◽

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 minutes before the hemodialysis session, 15 minutes before the start of hemodialysis session, every 5 minutes during the session, and 15 minutes 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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HEART RATE VARIABILITY IS A GOOD PREDICTOR OF SHOCK IN CRITICALLY ILL PATIENTS IN ICU

Critical Care Medicine ◽

10.1097/00003246-200412001-00343 ◽

2004 ◽

Vol 32 (Supplement) ◽

pp. A95

Author(s):

SHUNJI KASAOKA ◽

Kohtaro Kaneda ◽

Yoshikatsu Kawamura ◽

Ryosuke Tsuruta ◽

Kiyoshi Okabayashi ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Critically Ill ◽

Critically Ill Patients ◽

Good Predictor

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

10.21203/rs.3.rs-104514/v1 ◽

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.

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