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Examination of cardiovascular and peripheral autonomic function in the ICU: a pilot study

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Abstract

Critical illness may affect the autonomic nervous system. Decreased cardiovascular autonomic function measured by heart rate variability (HRV) has been reported in critically ill patients but limited information exists about other autonomic functions. The cold face test (CFT) and skin wrinkle test (SWT) have never been investigated in critically ill patients. Feasibility and safety of the CFT and SWT were investigated in critically ill patients. Exclusion criteria: polyneuropathy, autonomic neuropathy, admission after stroke, spinal cord injury or cardiac arrest. For the CFT, a cold pack was applied to the forehead to measure the maximal increase in RR interval. The simulated SWT was used and wrinkling was assessed on a five-point scale. HRV was investigated using power spectral analysis of continuous 5-min ECG recordings. Twelve critically ill patients were included (mean age 54). No adverse effects for the CFT and SWT were noted. The CFT could be performed in 10 patients and showed an abnormal response in 9. The SWT could be performed in 11 patients; results were abnormal in 6. HRV analysis showed decreased HRV in all patients. CFT and HRV responses were correlated with each other, no correlation was found between SWT and CFT or HRV results. The CFT and SWT are feasible and safe in critically ill patients. Cardiovascular dysfunction may be more prevalent in critical illness than peripheral sympathetic dysfunction. Influence of confounders and further validation of these tests needs to be investigated.

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Acknowledgments

The authors thank G. Sussenbach for his work on development of the HRV recording equipment and software. This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (http://www.ctmm.nl), project MARS (grant 04I-201). Dr. L. Wieske is supported by a personal grant from the Netherlands Organization for Health Research and Development (ZonMw–AGIKO grant [project number 40-00703-98-11636]).

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the 2008 Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, room G3-228, PO box 22700, 1105 AZ, Amsterdam, The Netherlands

    L. Wieske, E. R. Kiszer, M. J. Schultz & J. Horn

  2. Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands

    L. Wieske, C. Verhamme & I. N. van Schaik

  3. Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands

    L. Wieske & M. J. Schultz

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  1. L. Wieske
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  2. E. R. Kiszer
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  3. M. J. Schultz
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  4. C. Verhamme
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  5. I. N. van Schaik
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  6. J. Horn
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Correspondence to L. Wieske.

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Wieske, L., Kiszer, E.R., Schultz, M.J. et al. Examination of cardiovascular and peripheral autonomic function in the ICU: a pilot study. J Neurol 260, 1511–1517 (2013). https://doi.org/10.1007/s00415-012-6818-6

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  • DOI: https://doi.org/10.1007/s00415-012-6818-6

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