Journal Article

Increases in Heart Rate Variability Signal Improved Outcomes in Rapid Response Team Consultations: A Cohort Study

Malgapo, Melissa, Khurshid, Moazzum, Sharshir, Moh’d, Marashly, Qussay, Shafquat, Azam, Jamil, Mouhamad Ghyath, Hijazi, Mohammed, Ali, Zeeshan, Salahuddin, Nawal, Zaza, Khaled Juan, Shoukri, Mohamed, Al-Ghamdi, Bandar

2018

Overview

Background. Reduced heart rate variability (HRV) indicates dominance of the sympathetic system and a state of “physiologic stress.” We postulated that, in patients with critical illness, increases in HRV might signal successful resuscitation and improved prognosis. Methods. We carried out a prospective observational study of HRV on all patients referred to the rapid response team (RRT) and correlated with serial vital signs, lactate clearance, ICU admission, and mortality. Results. Ninety-one patients were studied. Significantly higher HRV was observed in patients who achieved physiological stability and did not need ICU admission: ASDNN 19 versus 34.5, p=0.032; rMSSD 13.5 versus 25, p=0.046; mean VLF 9.4 versus 17, p=0.021; mean LF 5.8 versus 12.4, p=0.018; and mean HF 4.7 versus 10.5, p=0.017. ROC curves confirmed the change in very low frequencies at 2 hours as a strong predictor for ICU admission with an AUC of 0.772 (95% CI 0.633, 0.911, p=0.001) and a cutoff value of −0.65 associated with a sensitivity of 78.6% and a specificity of 61%. Conclusions. Reduced HRV, specifically VLF, appears closely related to greater severity of critical illness, identifies unsuccessful resuscitation, and can be used to identify consultations that need early ICU admission.

• Publisher: Hindawi Publishing Corporation,Hindawi,John Wiley & Sons, Inc,Wiley
• Subject: Acidosis / Analysis / Blood pressure / Cardiac arrhythmia / Cohort analysis / Heart beat / Heart rate / Hospital patients / Medical research / Medicine, Experimental / Mortality / Patient outcomes / Patients / Physiological aspects / Physiology / Prognosis / Standard deviation / Teams