Abstract
Rev Bras Ter Intensiva. 2019;31(3):296-302
DOI 10.5935/0103-507X.20190054
Evaluate the physiological and autonomic nervous system responses of premature newborns to body position and noise in the neonatal intensive care unit.
A quasi-experimental study. The autonomic nervous system of newborns was evaluated based on heart rate variability when the newborns were exposed to environmental noise and placed in different positions: supine without support, supine with manual restraint and prone.
Fifty premature newborns were evaluated (gestational age: 32.6 ± 2.3 weeks; weight: 1816 ± 493g; and Brazelton sleep/awake level: 3 to 4). A positive correlation was found between environmental noise and sympathetic activity (R = 0.27, p = 0.04). The mean environmental noise was 53 ± 14dB. The heart rate was higher in the supine position than in the manual restraint and prone positions (148.7 ± 21.6, 141.9 ± 16 and 144 ± 13, respectively) (p = 0.001). Sympathetic activity, represented by a low frequency index, was higher in the supine position (p < 0.05) than in the other positions, and parasympathetic activity (high frequency, root mean square of the sum of differences between normal adjacent mean R-R interval and percentage of adjacent iRR that differed by more than 50ms) was higher in the prone position (p < 0.05) than in the other positions. The complexity of the autonomic adjustments (approximate entropy and sample entropy) was lower in the supine position than in the other positions.
The prone position and manual restraint position increased both parasympathetic activity and the complexity of autonomic adjustments in comparison to the supine position, even in the presence of higher environmental noise than the recommended level, which tends to increase sympathetic activity.
Abstract
Rev Bras Ter Intensiva. 2017;29(4):481-489
DOI 10.5935/0103-507X.20170072
To present a systematic review of the use of autonomic nervous system monitoring as a prognostic tool in intensive care units by assessing heart rate variability.
Literature review of studies published until July 2016 listed in PubMed/Medline and conducted in intensive care units, on autonomic nervous system monitoring, via analysis of heart rate variability as a prognostic tool (mortality study). The following English terms were entered in the search field: ("autonomic nervous system" OR "heart rate variability") AND ("intensive care" OR "critical care" OR "emergency care" OR "ICU") AND ("prognosis" OR "prognoses" OR "mortality").
There was an increased likelihood of death in patients who had a decrease in heart rate variability as analyzed via heart rate variance, cardiac uncoupling, heart rate volatility, integer heart rate variability, standard deviation of NN intervals, root mean square of successive differences, total power, low frequency, very low frequency, low frequency/high frequency ratio, ratio of short-term to long-term fractal exponents, Shannon entropy, multiscale entropy and approximate entropy.
In patients admitted to intensive care units, regardless of the pathology, heart rate variability varies inversely with clinical severity and prognosis.
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