Heart rate dynamics preceding hemorrhage in the intensive care unit.
Occult hemorrhage in surgical/trauma intensive care unit (STICU) patients is common and may lead to circulatory collapse. Continuous electrocardiography (ECG) monitoring may allow for early identification and treatment, and could improve outcomes. We studied 4,259 consecutive admissions to the STICU at the University of Virginia Health System. We collected ECG waveform data captured by bedside monitors and calculated linear and non-linear measures of the RR interbeat intervals. We tested the hypothesis that a transfusion requirement of 3 or more PRBC transfusions in a 24 hour period is preceded by dynamical changes in these heart rate measures and performed logistic regression modeling. We identified 308 hemorrhage events. A multivariate model including heart rate, standard deviation of the RR intervals, detrended fluctuation analysis, and local dynamics density had a C-statistic of 0.62. Earlier detection of hemorrhage might improve outcomes by allowing earlier resuscitation in STICU patients.
Division of Cardiovascular Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.
Travis J
TJ
Moss
Division of Cardiovascular Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.
Matthew T
MT
Clark
Department of Statistics, University of Virginia, Charlottesville, VA.
Douglas E
DE
Lake
Division of Cardiovascular Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA.
J Randall
JR
Moorman
Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA. Electronic address: calland@virginia.edu.
J Forrest
JF
Calland
D001803:Blood Transfusion / Q000401:mortality; D003422:Critical Care / Q000706:statistics & numerical data*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006470:Hemorrhage / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014768:Virginia / Q000453:epidemiology
Blood transfusion; Critical care; Heart rate dynamics; Hemorrhage; Physiologic monitoring; Statistical risk model