1. Heart rate dynamics preceding hemorrhage in the intensive care unit.
- Author
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Moss TJ, Clark MT, Lake DE, Moorman JR, and Calland JF
- Subjects
- Blood Transfusion mortality, Female, Heart Rate, Hemorrhage therapy, Hospital Mortality, Humans, Incidence, Male, Middle Aged, Prognosis, Proportional Hazards Models, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Survival Rate, Virginia epidemiology, Critical Care statistics & numerical data, Diagnosis, Computer-Assisted methods, Electrocardiography methods, Hemorrhage diagnosis, Hemorrhage mortality, Intensive Care Units statistics & numerical data
- 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., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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