Heart Rate Variability and Cerebral Autoregulation in Patients with Traumatic Brain Injury with Paroxysmal Sympathetic Hyperactivity Syndrome.

Autor: Burzyńska M; Clinical Department of Anesthesiology and Intensive Care, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland., Woźniak J; Department of Neurosurgery, Wroclaw University Hospital, Wroclaw, Poland., Urbański P; Clinical Department of Anesthesiology and Intensive Care, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland., Kędziora J; Clinical Department of Anesthesiology and Intensive Care, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland., Załuski R; Clinical Department of Neurosurgery, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland., Goździk W; Clinical Department of Anesthesiology and Intensive Care, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland., Uryga A; Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370, Wrocław, Poland. agnieszka.uryga@pwr.edu.pl.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2024 Oct 29. Date of Electronic Publication: 2024 Oct 29.
DOI: 10.1007/s12028-024-02149-1
Abstrakt: Background: Severe traumatic brain injury (TBI) can lead to transient changes in autonomic nervous system (ANS) functioning and development of paroxysmal sympathetic hyperactivity (PSH) syndrome. Clinical manifestation of ANS disorders may be obscured by therapeutic interventions in TBI. This study aims to analyze ANS metrics and cerebral autoregulation in patients with PSH syndrome to determine their significance in early prognostication.
Methods: This single-center retrospective study investigated the relationship between changes in ANS metrics, cerebral autoregulation, and PSH syndrome. Arterial blood pressure and intracranial pressure signals were monitored for 5 days post TBI. ANS metrics included time and frequency domain heart rate variability (HRV) metrics. Cerebral autoregulation was assessed using the pressure reactivity index.
Results: Sixty-six patients with severe TBI (median age 33 [interquartile range 26-50] years) were analyzed, and PSH was confirmed in nine cases. Impairment of cerebral autoregulation was observed in 67% of patients with PSH and 72% without the syndrome. Patients with PSH had higher HRV in the low-frequency range (LF; 253 ± 178 vs. 176 ± 227 ms 2 ; p = 0.035) and lower heart rates (HRs; 70 ± 7 vs. 78 ± 19 bpm; p = 0.027) compared to those without PSH. A receiver operating characteristic curve analysis indicated that HR (area under the curve (AUC) = 0.73, p = 0.006) and HRV in the LF (AUC = 0.70, p = 0.009) are moderate predictors of PSH. In the multiple logistic regression model for PSH, diffuse axonal trauma (odds ratio (OR) = 10.82, 95% confidence interval (CI) = 1.70-68.98, p = 0.012) and HR (OR = 0.91, 95%  CI 0.84-0.98, p = 0.021) were significant factors.
Conclusions: Elevated HRV in the LF and decreased HR may serve as early predictors of PSH syndrome development, particularly in patients with diffuse axonal trauma. Further research is needed to investigate the utility of the cerebral autoregulation-ANS relationship in PSH prognostication.
(© 2024. The Author(s).)
Databáze: MEDLINE
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