Pfeifer et al.(1111 Pfeifer R, Hopfe J, Ehrhardt C, Goernig M, Figulla HR, Voss A. Autonomic regulation during mild therapeutic hypothermia in cardiopulmonary resuscitated patients. Clin Res Cardiol. 2011;100(9):797-805.)
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Prospective cohort study Patients admitted to the ICU after cardiac arrest, subjected to therapeutic hypothermia N = 18 |
28-day mortality |
There was a more pronounced reduction in HRV immediately after the rewarming phase in patients who died compared with survivors (SDNN 10.9 versus 40.2, Shannon entropy 2.2 versus 3.7) |
15/24 |
Riordan et al.(1212 Riordan WP Jr., Norris PR, Jenkins JM, Morris JA Jr. Early loss of heart rate complexity predicts mortality regardless of mechanism, anatomic location, or severity of injury in 2178 trauma patients. J Surg Res. 2009;156(2):283-9.)
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Retrospective cohort study Multiple trauma patients admitted to the ICU N = 2,178 |
Risk of death in the subgroups based on trauma location and mechanism and on probability of survival |
Decreased MSE was significantly associated with increased mortality, being an independent factor of probability of survival in the multivariate analysis, with OR 0.87 - 0.94; the difference in median HR of MSE between survivors and non-survivors was highest (15.9 versus 5.9) when the primary trauma mechanism was penetrating |
10/24 |
Kahraman et al.(1313 Kahraman S, Dutton RP, Hu P, Stansbury L, Xiao Y, Stein DM, et al. Heart rate and pulse pressure variability are associated with intractable intracranial hypertension after severe traumatic brain injury. J Neurosurg Anesthesiol. 2010;22(4):296-302.)
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Prospective cohort study Patients admitted to the ICU with head trauma with Glasgow coma scale score < 9 and need for ICP monitoring N = 25 |
Capacity to predict intracranial hypertension, cerebral hypoperfusion, in-hospital mortality or functional outcome |
HRVi* can predict in-hospital mortality, with a sensitivity of 67% and a specificity of 91-100% |
15/24 |
Mowery et al.(1414 Mowery NT, Norris PR, Riordan W, Jenkins JM, Williams AE, Morris JA Jr. Cardiac uncoupling and heart rate variability are associated with intracranial hypertension and mortality: a study of 145 trauma patients with continuous monitoring. J Trauma. 2008;65(3):621-7.)
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Retrospective cohort study Patients with head trauma and ICP monitoring N = 145 |
Intracranial hypertension and mortality |
There is a relationship between percentage of ICP rise and cardiac decoupling with mortality. Each percentage increase had an increased risk of death of 1.04 and 1.03, respectively |
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Norris et al.(1515 Norris PR, Stein PK, Morris JA Jr. Reduced heart rate multiscale entropy predicts death in critical illness: a study of physiologic complexity in 285 trauma patients. J Crit Care. 2008;23(3):399-405.)
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Retrospective cohort study Trauma patients admitted to the ICU N = 285 |
In-hospital mortality |
There was a decrease in HRV (increase in HRVi*), OR 1.04 ± 0.01 and MSE OR 0.88 ± 0.03, in deceased patients |
12/24 |
Papaioannou et al.(1616 Papaioannou V, Giannakou M, Maglaveras N, Sofianos E, Giala M. Investigation of heart rate and blood pressure variability, baroreflex sensitivity, and approximate entropy in acute brain injury patients. J Crit Care. 2008;23(3):380-6.)
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Prospective cohort study Head trauma N = 20 |
Neurological dysfunction ICU mortality |
It was associated with increased mortality, reduced heart rate variability, reduced baroreflex sensitivity and sustained LF/HF ratio reduction |
17/24 |
Norris et al.(1717 Norris PR, Ozdas A, Cao H, Williams AE, Harrell FE, Jenkins JM, et al. Cardiac uncoupling and heart rate variability stratify ICU patients by mortality: a study of 2088 trauma patients. Ann Surg. 2006;243(6):804-12; discussion 812-4.)
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Retrospective cohort study Trauma patients admitted to the ICU N = 2,088 |
Mortality |
Cardiac decoupling was associated with increased mortality OR 1.035 - 1.052 |
13/24 |
Grogan et al.(1818 Grogan EL, Morris JA Jr., Norris PR, France DJ, Ozdas A, Stiles RA, et al. Reduced heart rate volatility: an early predictor of death in trauma patients. Ann Surg. 2004;240(3):547-54; discussion 554-6.)
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Retrospective cohort study Trauma patients admitted to the ICU N = 923 |
ICU mortality |
Patients with loss of heart rate volatility during the first 24 hours of hospitalization have a higher probability of death |
10/24 |
Rapenne et al.(1919 Rapenne T, Moreau D, Lenfant F, Vernet M, Boggio V, Cottin Y, et al. Could heart rate variability predict outcome in patients with severe head injury? A pilot study. J Neurosurg Anesthesiol. 2001;13(3):260-8.)
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Prospective cohort study Severe head trauma N = 20 |
Brain death Neurological recovery (Glasgow coma scale) |
On the first post-trauma day, an increase in the parasympathetic tone (rMSSD and TP) may be associated with imminent brain death |
17/24 |
Winchell et al.(2020 Winchell RJ, Hoyt DB. Analysis of heart-rate variability: a noninvasive predictor of death and poor outcome in patients with severe head injury. J Trauma. 1997;43(6):927-33.)
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Retrospective cohort study Patients with severe head trauma N = 80 |
Primary: in-hospital mortality and probability of discharge to the home Secondary: CPP and ICP |
Low HRV was associated with increased mortality; patients with a predominance of sympathetic activity and with a low HF/LF ratio had improved survival |
16/24 |
Brown et al.(2121 Brown SM, Tate Q, Jones JP, Knox DB, Kuttler KG, Lanspa M, et al. Initial fractal exponent of heart rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study. J Crit Care. 2013;28(6):959-63.)
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Prospective cohort study Patients admitted to the ICU with severe sepsis or septic shock N = 48 |
Primary outcome: suspension of vasoactive amines within the first 24 hours of ICU admission Secondary outcome: 28-day mortality |
The ratio between short- and long-term fractal exponents was associated with 28-day mortality; all patients who died had ratios < 0.75 |
18/24 |
Schmidt et al.(2222 Schmidt H, Hoyer D, Hennen R, Heinroth K, Rauchhaus M, Prondzinsky R, et al. Autonomic dysfunction predicts both 1- and 2-month mortality in middle-aged patients with multiple organ dysfunction syndrome. Crit Care Med. 2008;36(3):967-70.)
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Prospective cohort study Patients with multiple organ dysfunction syndrome N = 90 |
Analysis of survival at 180 and 365 days |
lnVLF† with a cutoff point of 3.9 was a strong predictor of 28-day and 2-month mortality in patients with multiple organ dysfunction syndrome |
18/24 |
Schmidt et al.(2323 Schmidt H, Müller-Werdan U, Hoffmann T, Francis DP, Piepoli MF, Rauchhaus M, et al. Autonomic dysfunction predicts mortality in patients with multiple organ dysfunction syndrome of different age groups. Crit Care Med. 2005;33(9):1994-2002.)
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Prospective cohort study Patients with multiple dysfunction syndrome N = 90 |
28-day mortality |
lnVLF† with a cut-off point of 3.9 was a strong predictor of 28-day mortality |
20/24 |
Gujjar et al.(2424 Gujjar AR, Sathyaprabha TN, Nagaraja D, Thennarasu K, Pradhan N. Heart rate variability and outcome in acute severe stroke: role of power spectral analysis. Neurocrit Care. 2004;1(3):347-53.)
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Prospective cohort study Acute stroke N = 25 |
ICU mortality |
LFn was an independent predictor of survival, with a regression coefficient of -6.73 and an OR of 0.002 |
19/24 |
Haji-Michael et al.(2525 Haji-Michael PG, Vincent JL, Degaute JP, van de Borne P. Power spectral analysis of cardiovascular variability in critically ill neurosurgical patients. Crit Care Med. 2000;28(7):2578-83.)
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Prospective cohort study Neurosurgical patients with Glasgow coma scale score < 13 N = 29 |
3-month outcome |
Patients who died had decreased HRV, LF/HF ratio and baroreflex sensitivity |
18/24 |
Papaioannou et al.(2626 Papaioannou VE, Maglaveras N, Houvarda I, Antoniadou E, Vretzakis G. Investigation of altered heart rate variability, nonlinear properties of heart rate signals, and organ dysfunction longitudinally over time in intensive care unit patients. J Crit Care. 2006;21(1):95-103; discussion 103-4.)
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Prospective cohort study General ICU population N = 53 |
ICU mortality |
The minimum ApEn value correlated with mortality (r = 0.41; p = 0.01) |
16/24 |
Yien et al.(2727 Yien HW, Hseu SS, Lee LC, Kuo TB, Lee TY, Chan SH. Spectral analysis of systemic arterial pressure and heart rate signals as a prognostic tool for the prediction of patient outcome in the intensive care unit. Crit Care Med. 1997;25(2):258-66.)
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Prospective cohort study General population admitted for noncardiac causes N = 52 |
Mortality |
Deceased patients had decreased VLF and LF band power |
16/24 |
Winchell et al.(2828 Winchell RJ, Hoyt DB. Spectral analysis of heart rate variability in the ICU: a measure of autonomic function. J Surg Res. 1996;63(1):11-6.)
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Prospective cohort study General ICU population N = 742 |
Mortality |
The relative risk of death in patients with low HRV was 7.4, with an increased HF/LF ratio of 4.55 |
19/24 |