A Narrative Review of Heart Rate and Variability in Sepsis

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2020 Jul 11

PMID 32647693

Citations 20

Authors

Benjamin Yi Hao Wee

Jan Hau Lee

Yee Hui Mok

Shu-Ling Chong

Affiliations

Soon will be listed here.

Abstract

Clinicians face challenges in the timely diagnosis and management of pediatric sepsis. Pediatric heart rate has been incorporated into early warning systems and studied as a predictor for critical illness. We aim to review: (I) the role of heart rate in pediatric warning systems and (II) the role of heart rate variability (HRV) in adult and neonatal sepsis, with a focus on its potential applications in pediatrics. We conducted a literature search for papers published up to December 2019 on the utility of heart rate and HRV analysis in the diagnosis and management of sepsis, using four medical databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical utility of pediatric heart rate in predicting clinical deterioration is limited by the lack of consensus among warning systems, consensus-based guidelines, and evidence-based studies as to what constitutes abnormal heart rate in the pediatric age group. Current studies demonstrate that abnormal heart rate itself does not adequately discriminate children with sepsis from those without. HRV analysis provides a quick and non-invasive method of assessment and can provide more information than traditional heart rate. HRV analysis has the potential to add value in identification and prognostication of adult and neonatal sepsis. With further studies to explore its role, HRV analysis has the potential to add to current tools in the diagnosis and prognosis of pediatric sepsis.

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References

Kamaleswaran R, Akbilgic O, Hallman M, West A, Davis R, Shah S . Applying Artificial Intelligence to Identify Physiomarkers Predicting Severe Sepsis in the PICU. Pediatr Crit Care Med. 2018; 19(10):e495-e503. DOI: 10.1097/PCC.0000000000001666. View

Griffin M, Lake D, Bissonette E, Harrell Jr F, OShea T, Moorman J . Heart rate characteristics: novel physiomarkers to predict neonatal infection and death. Pediatrics. 2005; 116(5):1070-4. DOI: 10.1542/peds.2004-2461. View

Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I . Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet. 2011; 377(9770):1011-8. PMC: 3789232. DOI: 10.1016/S0140-6736(10)62226-X. View

Sameshima H, Ikenoue T, Ikeda T, Kamitomo M, Ibara S . Association of nonreassuring fetal heart rate patterns and subsequent cerebral palsy in pregnancies with intrauterine bacterial infection. Am J Perinatol. 2005; 22(4):181-7. DOI: 10.1055/s-2005-867090. View

Pagani M, Malfatto G, Pierini S, Casati R, Masu A, Poli M . Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy. J Auton Nerv Syst. 1988; 23(2):143-53. DOI: 10.1016/0165-1838(88)90078-1. View

Kubota Y, Chen L, Whitsel E, Folsom A . Heart rate variability and lifetime risk of cardiovascular disease: the Atherosclerosis Risk in Communities Study. Ann Epidemiol. 2017; 27(10):619-625.e2. PMC: 5821272. DOI: 10.1016/j.annepidem.2017.08.024. View

Ruminski C, Clark M, Lake D, Kitzmiller R, Keim-Malpass J, Robertson M . Impact of predictive analytics based on continuous cardiorespiratory monitoring in a surgical and trauma intensive care unit. J Clin Monit Comput. 2018; 33(4):703-711. PMC: 9210030. DOI: 10.1007/s10877-018-0194-4. View

Goel V, Poole S, Longhurst C, Platchek T, Pageler N, Sharek P . Safety analysis of proposed data-driven physiologic alarm parameters for hospitalized children. J Hosp Med. 2016; 11(12):817-823. DOI: 10.1002/jhm.2635. View

Plunkett A, Tong J . Sepsis in children. BMJ. 2015; 350:h3017. DOI: 10.1136/bmj.h3017. View

10.

Scott H, Deakyne S, Woods J, Bajaj L . The prevalence and diagnostic utility of systemic inflammatory response syndrome vital signs in a pediatric emergency department. Acad Emerg Med. 2015; 22(4):381-9. DOI: 10.1111/acem.12610. View

11.

Cotterill S, Rowland A, Kelly J, Lees H, Kamara M . Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department. Emerg Med J. 2016; 33(11):756-762. PMC: 5136718. DOI: 10.1136/emermed-2015-204647. View

12.

Sandell J, Maconochie I . Paediatric early warning systems (PEWS) in the ED. Emerg Med J. 2016; 33(11):754-755. DOI: 10.1136/emermed-2016-205877. View

13.

Anderson T . Heart rate variability: implications for perioperative anesthesia care. Curr Opin Anaesthesiol. 2017; 30(6):691-697. DOI: 10.1097/ACO.0000000000000530. View

14.

Iroh Tam P, Bendel C . Diagnostics for neonatal sepsis: current approaches and future directions. Pediatr Res. 2017; 82(4):574-583. DOI: 10.1038/pr.2017.134. View

15.

Pong J, Fook-Chong S, Koh Z, Samsudin M, Tagami T, Chiew C . Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department. Int J Environ Res Public Health. 2019; 16(10). PMC: 6571945. DOI: 10.3390/ijerph16101725. View

16.

Barnaby D, Ferrick K, Kaplan D, Shah S, Bijur P, Gallagher E . Heart rate variability in emergency department patients with sepsis. Acad Emerg Med. 2002; 9(7):661-70. DOI: 10.1111/j.1553-2712.2002.tb02143.x. View

17.

van Wyk F, Khojandi A, Mohammed A, Begoli E, Davis R, Kamaleswaran R . A minimal set of physiomarkers in continuous high frequency data streams predict adult sepsis onset earlier. Int J Med Inform. 2019; 122:55-62. DOI: 10.1016/j.ijmedinf.2018.12.002. View

18.

Amiri P, Derakhshan A, Gharib B, Liu Y, Mirzaaghayan M . Identifying Optimal Features from Heart Rate Variability for Early Detection of Sepsis in Pediatric Intensive Care. Annu Int Conf IEEE Eng Med Biol Soc. 2020; 2019:1425-1428. DOI: 10.1109/EMBC.2019.8856346. View

19.

Fujimoto Y, Fukuki M, Hoshio A, Sasaki N, Hamada T, Tanaka Y . Decreased heart rate variability in patients with diabetes mellitus and ischemic heart disease. Jpn Circ J. 1996; 60(12):925-32. DOI: 10.1253/jcj.60.925. View

20.

Bohanon F, Mrazek A, Shabana M, Mims S, Radhakrishnan G, Kramer G . Heart rate variability analysis is more sensitive at identifying neonatal sepsis than conventional vital signs. Am J Surg. 2015; 210(4):661-7. PMC: 4575854. DOI: 10.1016/j.amjsurg.2015.06.002. View