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. 2017 Dec;5(1):33.
doi: 10.1186/s40635-017-0146-1. Epub 2017 Jul 12.

Heart rate variability in critical care medicine: a systematic review

Shamir N Karmali  1 , Alberto Sciusco  1 , Shaun M May  1 , Gareth L Ackland  2
Affiliations

Heart rate variability in critical care medicine: a systematic review

Shamir N Karmali et al. Intensive Care Med Exp. 2017 Dec.

Abstract

Background: Heart rate variability (HRV) has been used to assess cardiac autonomic activity in critically ill patients, driven by translational and biomarker research agendas. Several clinical and technical factors can interfere with the measurement and/or interpretation of HRV. We systematically evaluated how HRV parameters are acquired/processed in critical care medicine.

Methods: PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (1996-2016) were searched for cohort or case-control clinical studies of adult (>18 years) critically ill patients using heart variability analysis. Duplicate independent review and data abstraction. Study quality was assessed using two independent approaches: Newcastle-Ottowa scale and Downs and Black instrument. Conduct of studies was assessed in three categories: (1) study design and objectives, (2) procedures for measurement, processing and reporting of HRV, and (3) reporting of relevant confounding factors.

Results: Our search identified 31/271 eligible studies that enrolled 2090 critically ill patients. A minority of studies (15; 48%) reported both frequency and time domain HRV data, with non-normally distributed, wide ranges of values that were indistinguishable from other (non-critically ill) disease states. Significant heterogeneity in HRV measurement protocols was observed between studies; lack of adjustment for various confounders known to affect cardiac autonomic regulation was common. Comparator groups were often omitted (n = 12; 39%). This precluded meaningful meta-analysis.

Conclusions: Marked differences in methodology prevent meaningful comparisons of HRV parameters between studies. A standardised set of consensus criteria relevant to critical care medicine are required to exploit advances in translational autonomic physiology.

Keywords: Autonomic; Heart rate variability; Human; Systematic review.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

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Not applicable.

Competing interests

GLA is a member of the Associate editorial board of Intensive Care Medicine Experimental. GLA has received consultancy fees from Glaxo Smith Kline for unrelated purposes. The other authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Forest plot of individual effect sizes (Cohen’s d) across six studies investigating the relationship between LF/HF ratio and disease severity and mortality
See this image and copyright information in PMC

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