Heart rate variability as a marker of multiple organ dysfunction syndrome in deeply sedated, prepubescent patients: a secondary analysis
Abstract
Multiple organ dysfunction syndrome (MODS) is a frequent complication in critically ill patients. The objective of the present study in a pediatric intensive care unit was to determine the feasibility of using HRV to differentiate between deeply sedated patients with medium/high MODS and those with no/low MODS. This was a secondary analysis of data from the ANI EP clinical study (NCT04913038). Various HRV indices were computed in a 10-minute time window. A patient with a pediatric Sequential Organ Failure Assessment (pSOFA) score higher than 5 was classified into the medium/high MODS group. Forty-seven patients were selected for analysis. The Energy variable (equivalent to the standard deviation of normal-to-normal intervals) was significantly correlated with the pSOFA score (r²=-0.31, p = 0.03). HFnu values were higher in the medium/high MODS group than in the no/low MODS group (0.35 vs. 0.28, respectively; p = 0.019), and HFnu discriminated between the two groups of patients with an area under the receiver operating characteristic curve of 0.75 (sensitivity = 0.78, specificity = 0.74). Energy was slightly but not significantly lower in the medium/high MODS group (0.17, vs. 0.35 in the no/mild MODS group; p = 0.086). The results of our study in a PICU showed that HRV indices can differentiate between deeply sedated patients with MODS and those without. Further investigations are needed to confirm this finding and extend it to other populations.
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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