Key result
Autonomic dysfunction in severe tetanus is linked to ~46% lower SDNN.
Why the study?
Autonomic nervous system dysfunction is a significant cause of mortality in tetanus and currently relies on non-specific clinical signs for diagnosis.
Does heart rate variability indicate autonomic nervous system dysfunction in patients with severe tetanus?
Observational (n=9)
No
Does heart rate variability indicate autonomic nervous system dysfunction in patients with severe tetanus?
Heart rate variability is significantly reduced in severe tetanus patients with autonomic nervous system dysfunction and may serve as a valuable non-invasive diagnostic tool.
May support non-invasive ANSD monitoring in ventilated tetanus; leaves open diagnostic validity and clinical utility.
Autonomic nervous system dysfunction (ANSD) is a significant cause of mortality in tetanus. Currently diagnosis relies on non-specific clinical signs. Heart rate variability (HRV) may indicate underlying autonomic nervous system activity and represents a potentially valuable non-invasive tool for ANSD diagnosis in tetanus. HRV was measured from 3 5-minute ECG recordings during a 24-hour period in a cohort patients with severe tetanus, all receiving mechanical ventilation. HRV measurements from all subjects - 5 with ANSD (Ablett Grade 4) and 4 patients without ANSD (Ablett Grade 3) - showed HRV was lower than reported ranges for healthy individuals. Comparing different severities of tetanus, raw data for both time and frequency measurements of HRV were reduced in those with ANSD compared to those without. Differences were statistically significant in all except root mean square standard deviation RMSSD (p=0.07) indicating HRV may be a valuable tool in ANSD diagnosis.
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Duong et al. (2019) conducted an observational in Severe tetanus (n=9). Autonomic nervous system dysfunction (Ablett Grade 4) vs. Severe tetanus without autonomic nervous system dysfunction (Ablett Grade 3) was evaluated on Standard deviation of all normal-to-normal intervals (SDNN) (p=0.002). Severe tetanus patients with autonomic nervous system dysfunction exhibited significantly reduced heart rate variability, including lower SDNN (15.67 vs 28.82 ms, p=0.002), compared to those without.
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