Heart rate dynamics preceding hemorrhage in the intensive care unit

Journal of Electrocardiology
Travis J MossJames F Calland

Abstract

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.

References

Feb 3, 2009·Medical & Biological Engineering & Computing·M A PeñaR González-Camarena
Nov 3, 2010·American Journal of Physiology. Heart and Circulatory Physiology·Douglas E Lake, J Randall Moorman
Aug 26, 2011·The Journal of Pediatrics·Joseph Randall MoormanThomas Michael O'Shea
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Sep 18, 2014·Physiological Measurement·Travis J MossJ Randall Moorman

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Citations

Mar 16, 2017·Critical Care Medicine·Travis J MossJ Randall Moorman
Jun 23, 2018·Physiological Measurement·Jessica Keim-MalpassMatthew T Clark
Apr 20, 2017·IEEE Journal of Biomedical and Health Informatics·Marco De PasqualeManuela Ferrario
Jul 28, 2016·Critical Care Medicine·Travis J MossJ Randall Moorman
Apr 16, 2016·Critical Care Medicine·J Randall MoormanPlamen Ch Ivanov
Aug 20, 2018·Journal of Clinical Monitoring and Computing·Caroline M RuminskiJ Forrest Calland
Jan 12, 2021·International Journal of Nursing Studies Advances·Jessica Keim-Malpass, Liza P Moorman
Jan 29, 2019·The Journal of Pediatrics·Tellen D BennettMichael G Kahn

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