Giordano Giovanni, Alessandri Francesco, Tosi Antonella, Zullino Veronica, Califano Leonardo, Petramala Luigi, Galardo Gioacchino, Pugliese Francesco
Department of General and Specialistic Surgery, "Sapienza" University of Rome, 00185, Rome, Italy.
Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy.
J Clin Med. 2024 Dec 15;13(24):7634. doi: 10.3390/jcm13247634.
The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation (IMV). The protocol of this systematic review was registered with PROSPERO (CRD42024485800). We searched PubMed and Scopus databases from inception till March 2023 to identify randomized controlled trials and observational studies investigating HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation. Our primary outcome was to investigate HRV changes occurring during the weaning from IMV. Seven studies (n = 342 patients) were included in this review. All studies reported significant changes in at least one HRV parameter. The indices Low Frequency (LF), High Frequency (HF), and LF/HF ratio seem to be the most promising in predicting the outcome of weaning with reliability. Some HRV indices showed modification in response to different ventilator settings or modalities. Available data report HRV modifications during the process of weaning and suggest a promising role of some HRV indices in predicting weaning outcomes in critically ill patients. Point-of-care HRV monitoring systems might help to early detect patients at risk of weaning failure.
心率变异性（HRV）指标在预测撤机过程结果中的作用仍是一个有争议的话题。本研究的目的是调查接受有创机械通气（IMV）撤机的成年危重症患者的HRV分析。本系统评价的方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42024485800）。我们检索了从建库至2023年3月的PubMed和Scopus数据库，以识别调查接受有创机械通气撤机的成年危重症患者HRV分析的随机对照试验和观察性研究。我们的主要结局是调查IMV撤机期间发生的HRV变化。本评价纳入了7项研究（n = 342例患者）。所有研究均报告至少一项HRV参数有显著变化。低频（LF）、高频（HF）和LF/HF比值似乎在可靠预测撤机结果方面最具前景。一些HRV指标显示出对不同通气设置或模式的反应有所改变。现有数据报告了撤机过程中的HRV变化，并提示一些HRV指标在预测危重症患者撤机结果方面具有潜在作用。床旁HRV监测系统可能有助于早期发现有撤机失败风险的患者。
