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Erschienen in: Intensive Care Medicine 9/2013

01.09.2013 | Original

Autonomic dysfunction in ICU-acquired weakness: a prospective observational pilot study

verfasst von: L. Wieske, D. R. P. P. Chan Pin Yin, C. Verhamme, M. J. Schultz, I. N. van Schaik, J. Horn

Erschienen in: Intensive Care Medicine | Ausgabe 9/2013

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Abstract

Purpose

Intensive care unit-acquired weakness (ICU-AW) is a frequent complication of critical illness. It is unknown if patients with ICU-AW also have autonomic dysfunction, another frequent neurological complication of critical illness. We hypothesized that patients who develop ICU-AW also develop autonomic dysfunction. Furthermore, we hypothesized that patients with ICU-AW are more prone to develop autonomic dysfunction compared to patients without ICU-AW.

Methods

This was an observational cohort study of patients newly admitted to the ICU. Autonomic dysfunction was measured daily using heart rate variability (HRV) to a maximum of 15 days after admission. ICU-AW was diagnosed using the Medical Research Council score. Abnormal HRV was defined using age-matched reference values. The association between ICU-AW and HRV was analyzed using linear mixed effects models.

Results

We included 83 patients, 15 (18 %) of whom were diagnosed with ICU-AW. Of 279 HRV measurements, 204 could be analyzed. Abnormal HRV was found in all critically ill patients irrespective of the presence of ICU-AW (ICU-AW 100 % (IQR 71–100) vs. no ICU-AW 100 % (IQR 40–100); p = 0.40). Mechanical ventilation, sedation, norepinephrine, heart rate, and HRV artifacts were identified as confounders for HRV. ICU-AW was not associated with HRV.

Conclusion

Abnormal HRV is frequent in critically ill patients, both with and without ICU-AW. It is unlikely that patients with ICU-AW are more prone to develop abnormal HRV. However, we found that abnormal HRV may not be an accurate indicator of autonomic dysfunction because of confounders.
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Literatur
3.
Zurück zum Zitat Buchman TG, Stein PK, Goldstein B (2002) Heart rate variability in critical illness and critical care. Curr Opin Crit Care 8:311–315PubMedCrossRef Buchman TG, Stein PK, Goldstein B (2002) Heart rate variability in critical illness and critical care. Curr Opin Crit Care 8:311–315PubMedCrossRef
4.
5.
Zurück zum Zitat van Swieten JC, Koudstaal PJ, Visser MC et al (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607PubMedCrossRef van Swieten JC, Koudstaal PJ, Visser MC et al (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607PubMedCrossRef
7.
Zurück zum Zitat Task force of the European society of cardiology and the North American society of pacing and electrophysiology (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–381CrossRef Task force of the European society of cardiology and the North American society of pacing and electrophysiology (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–381CrossRef
8.
11.
Zurück zum Zitat American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874CrossRef American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874CrossRef
12.
Zurück zum Zitat Sakr Y, Lobo SM, Moreno R et al (2012) Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome. Crit Care 16:R222. doi:10.1186/cc11868 PubMedCrossRef Sakr Y, Lobo SM, Moreno R et al (2012) Patterns and early evolution of organ failure in the intensive care unit and their relation to outcome. Crit Care 16:R222. doi:10.​1186/​cc11868 PubMedCrossRef
13.
Zurück zum Zitat Ziegler D, Piolot R, Strassburger K et al (1999) Normal ranges and reproducibility of statistical, geometric, frequency domain, and non-linear measures of 24 h heart rate variability. Horm Metab Res 31:672–679. doi:10.1055/s-2007-978819 PubMedCrossRef Ziegler D, Piolot R, Strassburger K et al (1999) Normal ranges and reproducibility of statistical, geometric, frequency domain, and non-linear measures of 24 h heart rate variability. Horm Metab Res 31:672–679. doi:10.​1055/​s-2007-978819 PubMedCrossRef
15.
Zurück zum Zitat Korach M, Sharshar T, Jarrin I et al (2001) Cardiac variability in critically ill adults: influence of sepsis. Crit Care Med 29:1380–1385PubMedCrossRef Korach M, Sharshar T, Jarrin I et al (2001) Cardiac variability in critically ill adults: influence of sepsis. Crit Care Med 29:1380–1385PubMedCrossRef
16.
Zurück zum Zitat Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ (1984) Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 47:1223–1231PubMedCrossRef Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ (1984) Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 47:1223–1231PubMedCrossRef
17.
Zurück zum Zitat Bolton C, Thompson J, Bernardi L et al (2007) The cardiac R–R variation and sympathetic skin response in the intensive care unit. Can J Neurol Sci 34:313–315PubMed Bolton C, Thompson J, Bernardi L et al (2007) The cardiac R–R variation and sympathetic skin response in the intensive care unit. Can J Neurol Sci 34:313–315PubMed
18.
Zurück zum Zitat Eisenhut M (2012) Inflammation-induced desensitization of β-receptors in acute lung injury. Am J Respir Crit Care Med 185:894–895PubMedCrossRef Eisenhut M (2012) Inflammation-induced desensitization of β-receptors in acute lung injury. Am J Respir Crit Care Med 185:894–895PubMedCrossRef
20.
Zurück zum Zitat Sharshar T, Gray F, Lorin de la Grandmaison G et al (2003) Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock. Lancet 362:1799–1805PubMedCrossRef Sharshar T, Gray F, Lorin de la Grandmaison G et al (2003) Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock. Lancet 362:1799–1805PubMedCrossRef
21.
Zurück zum Zitat Wieske L, Kiszer ER, Schultz MJ et al (2012) Examination of cardiovascular and peripheral autonomic function in the ICU: a pilot study. J Neurol. doi:10.1007/s00415-012-6818-6 Wieske L, Kiszer ER, Schultz MJ et al (2012) Examination of cardiovascular and peripheral autonomic function in the ICU: a pilot study. J Neurol. doi:10.​1007/​s00415-012-6818-6
Metadaten
Titel
Autonomic dysfunction in ICU-acquired weakness: a prospective observational pilot study
verfasst von
L. Wieske
D. R. P. P. Chan Pin Yin
C. Verhamme
M. J. Schultz
I. N. van Schaik
J. Horn
Publikationsdatum
01.09.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 9/2013
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-013-2991-z

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