Prognostic significance of heart rate variability in pediatric intensive care patients

Objective: The aim of the current study is to investigate the diagnostic and prognostic values of Heart Rate Variability (HRV) according to sepsis, MODS (Multiple Organ Dysfunction Syndrome) and exitus status of inpatients follow up in PICU (Pediatric Intestive Care Unit). Materials and Method: Total of 111 out of 232 inpatients in Medical Faculty of Akdeniz PICU between August 2011 and September 2012 were included to the study. Demographic data, vital results and laboratory values and PELOD (Pediatric Logistic Organ Dysfunction), PIM-2 (Pediatric Index of Mortality 2), PRISM-3 (Pediatric Risk of Mortality) scores of the patients were recorded. The patients were grouped as SIRS, sepsis and severe sepsis, septic shock developing multiple organ failure and being exitus for hospitalized in PICU and follow ups. Results: All of the HRV values were significantly different between the Control-X and the Study-S group (p<0,01). Data indicated that time-domain variables which shows parasympathetic dysfunction such as RMSSD, NN50 and pNN50 were significantly different between the Study groups S-1, S-2 and Control group S. In addition, the values for HF and nHF which are frequency-domain parameters, the values for SDNN, Ti and Li which are indicating the total dysfunction and the values for LF and nLF which are frequency-domain parameters too were considerable low. At the time of admission, HRV variables did not reveal any statistically significant results on the third day data between the designated study group and control group. MODS developing and exitus patients had significantly different values for HRV values than those of the control group. Conclusions: HRV is a promising variable that can be used for diagnosis and follow-up at the early stage of sepsis. According to the third day results, HRV values return to normal values for patients recovered from sepsis. Further studies are needed to predict MODS and mortality and for HRV values that were resulted in significantly different values Key words: Heart Rate Variability, Sepsis, Multiple Organ Failure Syndrome, Pediatric Intensive Care Unit, mortality