Heart rate variability after acute traumatic brain injury in children

Abhik K. Biswas, William A. Scott, John F. Sommerauer, Peter M. Luckett

Research output: Contribution to journalArticle

135 Citations (Scopus)

Abstract

Objective: To evaluate heart rate variability (HRV) by power spectral analysis of heart rate and its relationship to intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcomes in children with acute traumatic head injury. Design: Prospective, case series. Setting: Pediatric intensive care unit in a level II trauma center/children's hospital. Subjects: Fifteen critically ill children with documented acute traumatic brain injury and four control subjects. Interventions: None. Measurements and Main Results: The normalized total power from 0.04 to 0.15 Hz was used to quantify low-frequency HRV and from 0.15 to 0.40 Hz to quantify high-frequency HRV. The ratio of low- to high-frequency (LF/HF) power was used as a measure of sympathetic modulation of heart rate. The power spectral data from the 5-min samples were averaged over each hour of data collection, and an hourly LF/HF ratio was obtained based on a 60-min electrocardiogram collection (twelve 5-min segments). The daily mean LF/HF ratio was calculated from the hourly LF/HF measurements. We found no linear correlation between the LF/HF ratio and either ICP or CPP (p = NS). There was a significant decrease in the LF/HF ratio when the intracranial pressure was >30 mm Hg (p < .001) or the cerebral perfusion pressure was <40 mm Hg (p < .001). Children with a Glasgow Coma Scale score of 3-4 had a lower LF/HF ratio compared with those who had a Glasgow Coma Scale score of 5-8 (p < .005). Patients who progressed to brain death had a markedly lower LF/HF ratio (p < .001), with a significant decrease after the first 4 hrs of hospitalization. Patients with more favorable outcomes had significantly higher LF/HF ratios. Conclusions: Our findings suggest that an ICP of >30 mm Hg or a CPP of <40 mm Hg may be associated with marked autonomic dysfunction and poor outcome. We speculate that HRV power spectral analysis may be a useful adjunct in determining the severity of neurologic insult and the prognosis for recovery in children. The LF/HF ratio may be helpful not only in identifying those patients who will progress to brain death but also in predicting which patients will have favorable outcomes.

Original languageEnglish (US)
Pages (from-to)3907-3912
Number of pages6
JournalCritical Care Medicine
Volume28
Issue number12
StatePublished - 2000

Fingerprint

Brain Injuries
Cerebrovascular Circulation
Heart Rate
Intracranial Pressure
Pediatric Intensive Care Units
Brain Death
Trauma Centers
Craniocerebral Trauma
Critical Illness
Nervous System
Traumatic Brain Injury
Electrocardiography

Keywords

  • Autonomic nervous system
  • Cerebral perfusion pressure
  • Children
  • Head injury
  • Head trauma
  • Heart rate variability
  • High-frequency power
  • Intracranial pressure
  • Low- to high-frequency ratio
  • Low-frequency power
  • Outcome
  • Pentobarbital
  • Power spectral analysis
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Heart rate variability after acute traumatic brain injury in children. / Biswas, Abhik K.; Scott, William A.; Sommerauer, John F.; Luckett, Peter M.

In: Critical Care Medicine, Vol. 28, No. 12, 2000, p. 3907-3912.

Research output: Contribution to journalArticle

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keywords = "Autonomic nervous system, Cerebral perfusion pressure, Children, Head injury, Head trauma, Heart rate variability, High-frequency power, Intracranial pressure, Low- to high-frequency ratio, Low-frequency power, Outcome, Pentobarbital, Power spectral analysis, Trauma",
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T1 - Heart rate variability after acute traumatic brain injury in children

AU - Biswas, Abhik K.

AU - Scott, William A.

AU - Sommerauer, John F.

AU - Luckett, Peter M.

PY - 2000

Y1 - 2000

N2 - Objective: To evaluate heart rate variability (HRV) by power spectral analysis of heart rate and its relationship to intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcomes in children with acute traumatic head injury. Design: Prospective, case series. Setting: Pediatric intensive care unit in a level II trauma center/children's hospital. Subjects: Fifteen critically ill children with documented acute traumatic brain injury and four control subjects. Interventions: None. Measurements and Main Results: The normalized total power from 0.04 to 0.15 Hz was used to quantify low-frequency HRV and from 0.15 to 0.40 Hz to quantify high-frequency HRV. The ratio of low- to high-frequency (LF/HF) power was used as a measure of sympathetic modulation of heart rate. The power spectral data from the 5-min samples were averaged over each hour of data collection, and an hourly LF/HF ratio was obtained based on a 60-min electrocardiogram collection (twelve 5-min segments). The daily mean LF/HF ratio was calculated from the hourly LF/HF measurements. We found no linear correlation between the LF/HF ratio and either ICP or CPP (p = NS). There was a significant decrease in the LF/HF ratio when the intracranial pressure was >30 mm Hg (p < .001) or the cerebral perfusion pressure was <40 mm Hg (p < .001). Children with a Glasgow Coma Scale score of 3-4 had a lower LF/HF ratio compared with those who had a Glasgow Coma Scale score of 5-8 (p < .005). Patients who progressed to brain death had a markedly lower LF/HF ratio (p < .001), with a significant decrease after the first 4 hrs of hospitalization. Patients with more favorable outcomes had significantly higher LF/HF ratios. Conclusions: Our findings suggest that an ICP of >30 mm Hg or a CPP of <40 mm Hg may be associated with marked autonomic dysfunction and poor outcome. We speculate that HRV power spectral analysis may be a useful adjunct in determining the severity of neurologic insult and the prognosis for recovery in children. The LF/HF ratio may be helpful not only in identifying those patients who will progress to brain death but also in predicting which patients will have favorable outcomes.

AB - Objective: To evaluate heart rate variability (HRV) by power spectral analysis of heart rate and its relationship to intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcomes in children with acute traumatic head injury. Design: Prospective, case series. Setting: Pediatric intensive care unit in a level II trauma center/children's hospital. Subjects: Fifteen critically ill children with documented acute traumatic brain injury and four control subjects. Interventions: None. Measurements and Main Results: The normalized total power from 0.04 to 0.15 Hz was used to quantify low-frequency HRV and from 0.15 to 0.40 Hz to quantify high-frequency HRV. The ratio of low- to high-frequency (LF/HF) power was used as a measure of sympathetic modulation of heart rate. The power spectral data from the 5-min samples were averaged over each hour of data collection, and an hourly LF/HF ratio was obtained based on a 60-min electrocardiogram collection (twelve 5-min segments). The daily mean LF/HF ratio was calculated from the hourly LF/HF measurements. We found no linear correlation between the LF/HF ratio and either ICP or CPP (p = NS). There was a significant decrease in the LF/HF ratio when the intracranial pressure was >30 mm Hg (p < .001) or the cerebral perfusion pressure was <40 mm Hg (p < .001). Children with a Glasgow Coma Scale score of 3-4 had a lower LF/HF ratio compared with those who had a Glasgow Coma Scale score of 5-8 (p < .005). Patients who progressed to brain death had a markedly lower LF/HF ratio (p < .001), with a significant decrease after the first 4 hrs of hospitalization. Patients with more favorable outcomes had significantly higher LF/HF ratios. Conclusions: Our findings suggest that an ICP of >30 mm Hg or a CPP of <40 mm Hg may be associated with marked autonomic dysfunction and poor outcome. We speculate that HRV power spectral analysis may be a useful adjunct in determining the severity of neurologic insult and the prognosis for recovery in children. The LF/HF ratio may be helpful not only in identifying those patients who will progress to brain death but also in predicting which patients will have favorable outcomes.

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KW - Cerebral perfusion pressure

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KW - Head injury

KW - Head trauma

KW - Heart rate variability

KW - High-frequency power

KW - Intracranial pressure

KW - Low- to high-frequency ratio

KW - Low-frequency power

KW - Outcome

KW - Pentobarbital

KW - Power spectral analysis

KW - Trauma

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