title: Continuous multiorgan variability analysis to track severity of organ failure in critically ill patients.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the utility of using continuous heart rate variability (HRV) and respiratory rate variability (RRV) monitoring for (a) tracking daily organ dysfunction in critically ill patients and (b) identifying patterns of variability changes during onset of shock and resolution of respiratory failure.
  
  
  METHODS
  Thirty-three critically ill patients experiencing respiratory and/or cardiac failure underwent continuous recording of their electrocardiogram and capnogram (CO2) waveforms from admission or intubation until discharge (maximum 14 days). HRV and RRV were computed in 5-minute overlapping windows, using Continuous Individualized Multi-organ Variability Analysis software. Multiple organ dysfunction scores were recorded daily. HRV and RRV trajectories were characterized during onset of shock and resolution of respiratory failure.
  
  
  RESULTS
  Both HRV and RRV decreased with increasing severity of multiple organ dysfunction scores for a variety of variability metrics. A decline in several measures of HRV and no decline in RRV were observed before onset of shock (n=6). In contrast, during resolution of respiratory failure, an increase in RRV was observed in patients who successfully passed extubation (n=12), with no change in RRV in those who subsequently failed extubation (n=2).
  
  
  CONCLUSIONS
  There is an association between reduced HRV and RRV and increasing organ dysfunction in critically ill patients. The significance of observing trends of decreasing HRV (with onset of shock) and increasing RRV (with resolution of respiratory failure) merits further investigation.
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: geoffgreen@ieee.org.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Green
authors.forename: Beverly
authors.initials: B
authors.lastname: Bradley
authors.forename: Andrea
authors.initials: A
authors.lastname: Bravi
authors.forename: Andrew J E
authors.initials: AJ
authors.lastname: Seely
mesh_terms: D016638:Critical Illness; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality / Q000503:physiopathology*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000503:physiopathology*; D012720:Severity of Illness Index; D012769:Shock / Q000401:mortality / Q000503:physiopathology; D012815:Signal Processing, Computer-Assisted
keywords: Critical illness; Extubation; HRV; MODS; RRV; Shock; Variability analysis