What is the clinical evidence from this study?

Study design: Observational. Population: Sepsis (n=15). Intervention: Heart rate variability (LFnu and LF/HF ratio). Primary outcome: Correlation of HRV variables with APACHE II and SOFA scores (r = -0.80).

What question did this study set out to answer?

To test the hypothesis that heart rate variability can indicate illness severity in sepsis patients in the emergency department.

July 1, 2002Academic Emergency Medicine

Heart Rate Variability in Emergency Department Patients with Sepsis

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Key result

Heart rate variability parameter LFnu correlated inversely with illness severity as measured by SOFA (r = -0.80) and APACHE II (r = -0.67) scores in emergency department patients with sepsis.

Why the study?

Does heart rate variability provide an early indication of illness severity among patients presenting to the emergency department with sepsis?

Population

15 emergency department patients meeting the American College of Chest Physicians/Society of Critical Care…

Design

Cohort

Follow-up

5 days

Authors

DBDouglas P. BarnabyCross-Cutting Cardiology KFKevin J. FerrickAlbert Einstein College of Medicine DKDaniel T. KaplanRutgers Sexual and Reproductive Health and Rights

Discussion

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Implication

LFnu may indicate sepsis severity in the ED; hypothesis-generating and requires prospective validation before clinical adoption.

Key Points

To test the hypothesis that heart rate variability can indicate illness severity in sepsis patients in the emergency department.
Convenience sample of 15 emergency department patients with sepsis
Continuous Holter monitoring for heart rate variability in ED
Correlation analysis of HRV variables with APACHE II and SOFA scores.
LFnu correlated with APACHE II score (r = -0.67, r(2) = 0.43) and SOFA score (r = -0.80, r(2) = 0.64)
All patients needing critical care or who died had LFnu < 0.5 and LF/HF < 1.0
No patients with LFnu > 0.5 required critical interventions during the first five days after admission.

Study Design

Type

Observational (n=15)

Structured PICO

Does heart rate variability provide an early indication of illness severity among patients presenting to the emergency department with sepsis?

Population

15 emergency department patients meeting criteria for sepsis, evaluated with continuous Holter monitoring.

Exposure

Heart rate variability (HRV) measurement via continuous Holter monitoring (analyzing a 5-minute segment)

Outcome

Correlation of HRV variables (LFnu, LF/HF ratio) with APACHE II and SOFA scoressurrogate

Main Result

Effect estimate: r = -0.80

A brief 5-minute measurement of heart rate variability (LFnu) in the ED correlates strongly with illness severity scores and may serve as an early noninvasive marker of clinical deterioration in sepsis.

Limitations

The threshold effect of LFnu and LF/HF in the prediction of early clinical deterioration was an unexpected finding and should be regarded as hypothesis-generating, pending further study.
Small sample size (convenience sample of 15 patients)
Threshold effect findings are hypothesis-generating pending further study

Cite This Study

Barnaby et al. (2002) conducted an observational in Sepsis (n=15). Heart rate variability (LFnu and LF/HF ratio) was evaluated on Correlation of HRV variables with APACHE II and SOFA scores (r = -0.80). Heart rate variability parameter LFnu correlated inversely with illness severity as measured by SOFA (r = -0.80) and APACHE II (r = -0.67) scores in emergency department patients with sepsis.

synapsesocial.com/papers/6a33751e6b65369c445ea040 https://doi.org/10.1111/j.1553-2712.2002.tb02143.x

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Heart Rate Variability in Emergency Department Patients with Sepsis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Heart Rate Variability in Emergency Department Patients with Sepsis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider