313 - Heart-Rate Variability (HRV) prior to Adverse Cardio-Pulmonary Events in Critically Ill Children in the Intensive Care Unit

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 313
Publication Number: 313.205

Shreya Chandran, Driscoll Children's Hospital, Bangalore, Karnataka, India; Christina T. Nguyen, University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, United States; Joshua Kuehne, University of Incarnate Word School of Osteopathic Medicine, Boerne, TX, United States; UTPAL BHALALA, Driscoll Children's Hospital, CORPUS CHRISTI, TX, United States

Presenting Author(s)

Shreya Chandran, MBBS (she/her/hers)

Student researcher
Driscoll Children's Hospital
Bangalore, Karnataka, India

Background: Loss of heart rate variability is well-described prior to shock and cardiac arrest in adult and select pediatric patients. There is a lack of sufficient data on the occurrence of loss of HRV prior to adverse cardiopulmonary events (CPE) in children in the intensive care unit (ICU).

Objective:
We aimed to assess the occurrence of any loss of HRV prior to adverse CPE in children admitted to the ICU.

Design/Methods: We conducted a prospective, observational study assessing HRV 1-hour prior to any adverse CPE in children admitted to our combined ICU between July-October 2022. An adverse CPE was defined a priori as any deterioration in cardiac and/or pulmonary status which required a cardiac and/or pulmonary intervention. We collected patient demographic and clinical data and central monitor data, especially cardiac tracing at 1-hour prior to the event. We measured R-R intervals and determined time-domain (TD), frequency-domain (FD), and non-linear metric components of HRV using LabChart Pro software. We analyzed and interpreted our results with reference to standard HRV values for age and gender.

Results:
A total of 89 CPEs were recorded in 31 critically ill children in our ICU between July and October 2022. The median (IQR) age was 8.86(0.32-58.47) months with 46.87% males and 71.87% Hispanic White. Among the CPEs, 59.78% were pulmonary, 32.6% cardiac and 21.87% were cardio-pulmonary in origin. The median values of time-domain parameters of HRV [SDRR 38 ms, reference range 60(42-78); RMSSD 46 ms, reference range 66(44-91); pRR50% 21, reference range 38(20-52)] were abnormal. Similarly, the median values of frequency-domain parameters of HRV [LF 185 ms2, reference range 550(262-953); HF 288 ms2, reference range 967(441-1587); and LF/HF ratio 0.58, reference range 0.62(0.42-0.95)] were abnormal. Lastly, the median values of non-linear metrics [SD1 32.2 ms, reference range 49.1(31.7-70.2) and SD2 42.3 ms, reference range 205(172.6-246.4)] were abnormal. Based on abnormalities of atleast one domain of HRV, a total of 71/89 (80%) events exhibited a loss of HRV within 1 hour prior to cardio-pulmonary deterioration.

Conclusion(s):
In our cohort of critically ill children, there was a loss of HRV based on abnormalities in at least one of the three domains of HRV, 1-hour prior to CPE.