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Sophie Martin
PICU Fellow
Sainte Justine Hospital
Montréal, QC, Canada
Disclosure information not submitted.
Guillaume Emeriaud, MD, PhD
Department of Pediatrics, Pediatric Intensive Care Unit
CHU Sainte Justine. Université de Montréal, United States
Disclosure information not submitted.
Geneviève Du Pont-Thibodeau, MD, MSc
Pediatric-Intensivist
CHU Sainte-Justine, Quebec, Canada
Disclosure information not submitted.
Laurence Ducharme-Crevier, MD, MD MSc (she/her/hers)
Pediatric Intensivist
CHU Sainte Justine. Université de Montréal
Montreal, QC, Canada
Disclosure information not submitted.
Title: Heart rate variability in children with traumatic brain injury: a prospective observational study
Objective: Assess feasibility of continuous monitoring of heart rate variability (HRV) in children with traumatic brain injury (TBI) hospitalized in a Pediatric Intensive Care Unit (PICU) and obtain preliminary data on the association between HRV, neurological outcome and adverse events.
Design: Prospective observational cohort study
SETTING: Tertiary academic PICU.
PATIENTS: Children admitted to the PICU ≤24h after moderate or severe TBI. Children suspected of being brain death at admission or with a pacemaker were excluded.
INTERVENTION: None
MEASUREMENTS: Children underwent continuous monitoring of electrocardiographic (ECG) waveforms for 7 days post TBI. HRV analysis was performed retrospectively, using a standardized, validated HRV analysis software (CIMVA). The occurrence adverse events (intracranial hypertension, low cerebral perfusion pressure, seizures and cardiac arrest) was documented. Outcome of children 6 months post TBI was assessed using the Pediatric Glasgow Outcome Scale Extended.
MAIN
Results: 15 patients were included over a 20-month period. Thirteen patients had ECG recordings available and 4 had >20% of missing ECG data. However, when ECG was available, HRV calculation was mostly feasible (lowest 70%, highest 97%). Significant decreased in HRV Coefficient of variation (p < 0.05) and Poincaré SD2 (p < 0.01) at 6-hour post PICU admission was associated with an unfavorable outcome. Most of the HRV frequency-domain measures exhibited a statistically significant drop in variability during high ICP (HF and LF Power, p< 0.01) or low CPP episodes (LF/HF ratio, LF Power, p< 0.05). Seizures and episodes of high ICP were also associated with decreased HRV non-linear measures (Poincaré SD1 and SD2, p< 0.01) and Coefficient of Variation (p < 0.01). Seizures were associated an increased LF/HF ratio and LF Power (p < 0.01).
Conclusions: This study demonstrates that it is feasible to detect HRV changes in the PICU, but systematic HRV monitoring remains a challenge. HRV may be a promising prognostic factor to predict neurological outcome in moderate to severe TBI patients. HRV also appears to predict in-hospitals secondary adverse events. Larger prospective studies are needed to confirm these results.