Could Heart Rate Variability Predict Outcome In Patients With Severe Head Injury?
| Autor: | Daniel Moreau, Yves Cottin, François Lenfant, Marc Freysz, Magali Vernet, Vincent Boggio, Thierry Rapenne |
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| Rok vydání: | 2001 |
| Předmět: |
Male
Brain Death medicine.medical_specialty Resuscitation Poison control Blood Pressure Pilot Projects Head trauma Heart Rate Predictive Value of Tests Internal medicine medicine Craniocerebral Trauma Humans Heart rate variability Glasgow Coma Scale Prospective cohort study Monitoring Physiologic Receiver operating characteristic business.industry Patient Selection Head injury Accidents Traffic Arrhythmias Cardiac medicine.disease Surgery Survival Rate Treatment Outcome Anesthesiology and Pain Medicine ROC Curve Brain Injuries Disease Progression Cardiology Accidental Falls Female Neurology (clinical) business Body Temperature Regulation |
| Zdroj: | Journal of Neurosurgical Anesthesiology. 13:260-268 |
| ISSN: | 0898-4921 |
| DOI: | 10.1097/00008506-200107000-00016 |
| Popis: | Despite major improvements in the resuscitation of patients with head injury, the outcome of patients with head trauma often remains poor and difficult to establish. Heart rate variability (HRV) analysis is a noninvasive tool used to measure autonomic nervous system (ANS) activity. The aim of this prospective study was to investigate whether HRV analysis might be a useful adjunct for predicting outcome in patients with severe head injury. Twenty patients with severe head trauma (Glasgow Coma Scale [GCS]or= 8) underwent 24-hour electrocardiogram recording 1 day after trauma and again 48 hours after withdrawal of sedative drugs. Heart rate variability was assessed, in both time domain and spectral domain. The authors initially compared (on Day 1) HRV in patients who progressed to brain death to HRV in survivors; then during the awakening period compared HRV in surviving patients with good recovery (GCSor= 10) to HRV in patients characterized by a worsened neurologic state (GCS10). Statistical analysis used the Kruskal-Wallis test, P.05. To assess whether HRV could predict evolution to brain death, receiver operating characteristic (ROC) curves were generated the day after trauma for Total Power, natural logarithm of high-frequency component of spectral analysis (LnHF), natural logarithm of low-frequency component of spectral analysis (LnLF), and root mean square for successive interval differences (rMSSD). Seven patients died between Day 1 and Day 5 after trauma. Six of those had progressed to brain death. In these six patients, at Day 1, Global HRV and parasympathetic tone were significantly higher. Referring to the area under the rMSSD ROC curve, HRV might provide useful information in predicting early evolution of patients with severe head trauma. During the awakening period, global HRV and the parasympathetic tone were significantly lower in the worsened neurologic state group. In conclusion, HRV could be helpful as a predictor of imminent brain death and a useful adjunct for predicting the outcome of patients with severe head injury. |
| Databáze: | OpenAIRE |
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