Cristian Aragón-Benedí1,2, Pablo Oliver-Forniés2,3, Felice Galluccio2,4, Ece Yamak Altinpulluk2,5,6,7, Tolga Ergonenc2,8,9, Abdallah El Sayed Allam2,10, Carlos Salazar2,11, Mario Fajardo-Pérez1,2. 1. Department of Anesthesia, Resuscitation and Pain Therapy, Mostoles General University Hospital, Mostoles, Madrid, Spain. 2. Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain. 3. Department of Anesthesia, Resuscitation and Pain Therapy, Lozano Blesa University Clinic Hospital, Zaragoza, Aragón, Spain. 4. Department of Clinical and Experimental Medicine, University Hospital AOU Careggi, Florence, Italy. 5. Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America. 6. Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey. 7. Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey. 8. Department of Anesthesiology, Akyazi Pain and Palliative Care Center, Sakarya, Turkey. 9. Sakarya Education and Research Hospital, Sakarya, Turkey. 10. Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine and University Hospital, Tanta University, Tanta, Egypt. 11. Department of Anesthesia, Hospital Universitario 12 de Octubre, Madrid, Spain.
Abstract
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.
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 illpatients. We conducted this study to show the different spectral frequency and time domain parameters of HRV as a prospective predictor for critically illpatients, and in particular for COVID-19patients who are on mechanical ventilation. The hypothesis is that most severely ill COVID-19patients 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-19patients 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-19patients are associated with a worse prognosis, higher mortality, and higher IL-6 levels.
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