Chen I-Chen, Kor Chew-Teng, Lin Ching-Hsiung, Kuo Jane, Tsai Jang-Zern, Ko Wen-Je, Kuo Cheng-Deng
Intensive Care Units, National Taiwan University Hospital, Taipei, Taiwan.
Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.
BMC Anesthesiol. 2018 Apr 2;18(1):34. doi: 10.1186/s12871-018-0497-5.
The morbidity and mortality of acute respiratory distress syndrome (ARDS) remains high, and the strategic focus of ARDS research has shifted toward identifying patients at high risk of mortality early in the course of illness. This study intended to identify the heart rate variability (HRV) measure that can predict the outcome of patients with ARDS on admission to the surgical intensive care unit (SICU).
Patients who had lung or esophageal cancer surgery were included either in the ARDS group (n = 21) if they developed ARDS after surgery or in the control group (n = 11) if they did not. The ARDS patients were further stratified into survivors and non-survivors subgroups according to their outcomes. HRV measures of the patients were used for statistical analysis.
The mean RR interval (mRRI), high-frequency power (HFP) and product of low-/high-frequency power ratio tidal volume and tidal volume (LHR*V) were significantly lower (p < 0.05), while the normalized HFP to V ratio (nHFP/V) was significantly higher in the ARDS patients (p = 0.011). The total power (TP), low-frequency power (LFP), HFP and HFP/V were all significantly higher in the non-survived ARDS patients, whereas Richmond Agitation-Sedation Scale (RASS) was significantly lower in the non-survived ARDS patients. After adjustment for RASS, age and gender, firth logistic regression analysis identified the HFP, TP as the significant independent predictors of mortality for ARDS patients.
The vagal modulation of thoracic surgical patients with ARDS was enhanced as compared to that of non-ARDS patients, and the non-survived ARDS patients had higher vagal activity than those of survived ARDS patients. The vagal modulation-related parameters such as TP and HFP were independent predictors of mortality in patients with ARDS on admission to the SICU, and the HFP was found to be the best predictor of mortality for those ARDS patients. Increased vagal modulation might be an indicator for poor prognosis in critically ill patients following thoracic surgery.
急性呼吸窘迫综合征（ARDS）的发病率和死亡率仍然很高，ARDS研究的战略重点已转向在疾病早期识别高死亡风险患者。本研究旨在确定可预测ARDS患者入住外科重症监护病房（SICU）时预后的心率变异性（HRV）指标。
接受肺或食管癌手术的患者，若术后发生ARDS则纳入ARDS组（n = 21），若未发生ARDS则纳入对照组（n = 11）。ARDS患者根据其预后进一步分为存活者和非存活者亚组。对患者的HRV指标进行统计分析。
ARDS患者的平均RR间期（mRRI）、高频功率（HFP）以及低频/高频功率比与潮气量的乘积（LHR*V）显著降低（p < 0.05），而标准化HFP与V的比值（nHFP/V）显著升高（p = 0.011）。非存活ARDS患者的总功率（TP）、低频功率（LFP）、HFP和HFP/V均显著更高，而非存活ARDS患者的里士满躁动镇静评分（RASS）显著更低。在对RASS、年龄和性别进行校正后，费舍尔逻辑回归分析确定HFP、TP为ARDS患者死亡的显著独立预测因素。
与非ARDS患者相比，ARDS胸外科患者的迷走神经调节增强，非存活ARDS患者的迷走神经活动高于存活ARDS患者。迷走神经调节相关参数如TP和HFP是ARDS患者入住SICU时死亡的独立预测因素，且发现HFP是这些ARDS患者死亡的最佳预测因素。迷走神经调节增加可能是胸外科重症患者预后不良的一个指标。
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