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• W2313311222 abstract "Introduction: Both heart rate (HR) and respiratory rate (RR) are important vital signs. Decreased HR variability, expressed as RR interval, has been reported to be associated with morbidity and mortality in septic patients. In addition, decreased RR variability during mechanical ventilation as measured using flow rate, tidal volume, etc., is reported to be related with mortality or unsuccessful weaning from a mechanical ventilator. Integer heart rate (HRi) and integer respiratory rate (RRi) are routinely measured by a bedside medical device every 15-60 seconds, and the data are easily accessed in the ICU. We hypothesized that variability of HRi or RRi could be associated with APACHE II score or SOFA score in ICU septic patients. Methods: Adult subjects with a diagnosis of sepsis consecutively admitted to our ICU between August 2012 and July 2013 were prospectively included. Subjects with an ICU stay <48hrs or receiving muscle relaxants except during tracheal intubation were excluded. Data for HRi or RRi measured using a bedside medical device (Intellivue®, Philips, Japan) every minute were automatically stored in an ICU information system (Fortec ACSYS®, Philips, Japan). Values of mean (m), standard deviation (SD), approximate entropy (ApEn), and detrended fluctuation analysis (α1-exponent) were computed on the HRi or RRi data from the initial 24hr after admission as well as throughout the ICU stay using Matlab® (Mathworks, Japan). APACHE II score and daily SOFA score were also evaluated. Pearson coefficient was used to test the correlation between APACHE II score and m, SD, ApEn, and α1-exponent, or between SOFA score and m, SD, ApEn, and α1-exponent. Differences between survivors and non-survivors were compared using Student's t test. P<0.05 was considered statistically significant. Results: A total of 41 subjects (23F/18M, age=65 ± 16 [m±SD] years) were enrolled. Diagnoses on admission included sepsis (N=10), severe sepsis (N=20), and septic shock (N=11). Length of ICU stay was 13 ± 10 days. Twenty-one of 41 subjects received invasive mechanical ventilation (mainly SIMV mode) and were sedated with a target RASS score between -2 and 0 with continuous infusion of propofol or dexmedetomidine with/without fentanyl. Four subjects died, and 37 subjects survived their ICU stay. APACHE II score was significantly correlated with initial 24hr SOFA score (r=0.80, p<0.01), mean SOFA score (r=0.78, p<0.01), SD of HRi and RRi (r=0.50 and r=0.43, p<0.01 for both), and ApEn of HRi and RRi (r=-0.34 and r=-0.41, p<0.05 and p<0.01, respectively). Mean SOFA scores were significantly correlated with initial 24hr SOFA score (r=0.87, p<0.01), SD of RRi (r=0.53, p<0.01), ApEn of RRi and HRi (r=-0.54 and r=-0.32, p<0.01 and p<0.05, respectively), and α1-exponent of RRi (r=0.36, p<0.05). There were no significant correlations between APACHE II score or mean SOFA score and SD, ApEn, or α1-exponent based on HRi and RRi data during the initial 24hrs after admission. APACHE II score (20 ± 8 vs. 36 ± 4, p<0.01), mean SOFA score (9.1 ± 2.5 vs. 16.6 ± 3.4, p<0.01), SD of RRi (4.1 ± 0.8 vs. 5.6 ± 2.6, p<0.01), and ApEn of HRi (0.83 ± 0.42 vs. 0.44 ± 0.21, p<0.05) and RRi (1.78 ± 0.30 vs. 1.27 ± 0.33, p<0.05) were significantly different between survivors (n=37) and non-survivors (n=4). Conclusions: Variability of RRi and HRi data from a bedside medical device expressed as SD or ApEn may reflect degree of organ dysfunction in septic ICU patients." @default.
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• W2313311222 date "2013-12-01" @default.
• W2313311222 modified "2023-10-14" @default.
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• W2313311222 doi "https://doi.org/10.1097/01.ccm.0000439818.36331.58" @default.
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