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Respiratory induced heart rate variability during slow mechanical ventilation

Marker to exclude brain death patients

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Summary

Background

Respiratory induced heart rate variability (rHRV) was analysed in mechanically ventilated patients during two levels of sedation and brain death. Our aim was to determine whether rHRV can distinguish between different levels of sedation and especially between brain death and sedated patients.

Methods

In this study 30 critically ill and 23 brain death patients were included and four respiratory rates of 15, 12, 8 and 6 breaths per minute, each lasting 5 min were used. Two sedation levels, basal and deep, were performed in the critically ill patients. Heart rate and blood pressure changes induced by ventilation were subsequently detected and analysed.

Results

Significant differences were found in rHRV and rHRV adjusted for tidal volume (rHRV/VT) between critically ill and brain death patients during slow breathing at 6 or 8 breaths per minute. The rHRV at 6 breaths per minute was below 15 ms in all brain death subjects except one. The rHRV/VT was lower than 25 ms/l at both 6 and 8 breaths per minute in all brain death patients and simultaneously at 75% of non-brain death patients was higher (specificity 1, sensitivity 0.24). Differences in rHRV and rHRV/VTs between basal and deep sedation were not significant.

Conclusions

The main clinical benefit of the study is the finding that rHRV and rHRV/VT during 6 and 8 breaths per minute can differentiate between critically ill and brain death patients. An rHRV/VT exceeding 25 ms/l reliably excludes brain death.

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Acknowledgements

The study was supported by the research projects: grant GACR P103/11/0933; IGA Ministry of Health Czech Republic, MEYS CR (LO1212), its infrastructure by MEYS CR and EC (CZ.1.05/2.1.00/01.0017), by European Regional Development Fund project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123) and by ASCR (RVO:68081731), supported by IGA Ministry of Health Czech Republic. NS 10105-3.

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Authors and Affiliations

  1. Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic

    Pavel Jurak, Josef Halamek & Vlastimil Vondra

  2. International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic

    Pavel Jurak, Josef Halamek, Vlastimil Vondra & Pavel Leinveber

  3. Laboratory of Structural Biology and Proteomis, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho tr. 1946/1, 612 42, Brno, Czech Republic

    Peter Kruzliak

  4. Department of Anaesthesiology and Intensive Care, St. Anne’s University Hospital and Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic

    Vladimir Sramek, Ivan Cundrle &  Vaclav Zvonicek

  5. Department of Thoracic Surgery, Faculty of Medicine and Dentistry, Medical University of Silesia, Katowice, Poland

    Mariusz Adamek

Authors
  1. Pavel Jurak
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  2. Josef Halamek
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Corresponding author

Correspondence to Peter Kruzliak.

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Conflict of interest

P. Jurak, J. Halamek, V. Vondra, P. Kruzliak, V. Sramek, I. Cundrle, P. Leinveber, M. Adamek and V. Zvonicek declare that they have no competing interests.

Ethical standards

All procedures described in this manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1964 (in its current revised form). Informed consent was obtained from the next of kin or legal representative of all patients included in the study.

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Jurak, P., Halamek, J., Vondra, V. et al. Respiratory induced heart rate variability during slow mechanical ventilation. Wien Klin Wochenschr 129, 251–258 (2017). https://doi.org/10.1007/s00508-017-1176-0

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  • DOI: https://doi.org/10.1007/s00508-017-1176-0

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