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Licensed Unlicensed Requires Authentication Published by De Gruyter October 25, 2006

Attenuated autonomic function in multiple organ dysfunction syndrome across three age groups

  • Hendrik Schmidt , Ursula Müller-Werdan , Thomas Hoffmann , Dárrel P. Francis , Massimo F. Piepoli , Mathias Rauchhaus , Roland Prondzinsky , Harald Loppnow , Michael Buerke , Dirk Hoyer and Karl Werdan

Abstract

Multiple organ dysfunction syndrome (MODS) is the failure of several organs after a trigger event. The mortality is high, at up to 70%. We hypothesize that autonomic dysfunction may substantially contribute to the development of MODS and speculate that there is an age dependence of autonomic dysfunction in MODS. A total of 90 consecutively admitted MODS patients were assigned to this study. Three variables of autonomic function were analyzed: heart rate variability (HRV), baroreflex sensitivity (BRS) and chemoreflex sensitivity (CRS). The patient cohort was divided into three age groups. The main finding was that BRS, CRS and almost all indices of HRV were attenuated in comparison to normal range data and there was no age dependence for HRV indices or CRS, but there was for BRS. In conclusion, autonomic function in MODS is attenuated. The influence of MODS on autonomic function overwhelms the age dependence of autonomic function observed in healthy subjects.


Corresponding author: Hendrik Schmidt, MD, Department of Medicine III, Martin Luther University Halle-Wittenberg, E.-Grube-Str. 40, 06120 Halle, Germany Phone: +49-345-5572601 Fax: +49-345-5572072

References

1 Task Force of the European Society of Cardiology and North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996; 17: 354–381.Search in Google Scholar

2 Cohen J. The immunopathogenesis of sepsis. Nature2002; 420: 885–891.10.1038/nature01326Search in Google Scholar

3 Garrard CS, Kontoyannis DA, Piepoli M. Spectral analysis of heart rate variability in sepsis syndrome. Clin Auton Res1993; 3: 5–13.10.1007/BF01819137Search in Google Scholar

4 Godin PJ, Buchman TG. Uncoupling of biological oscillators: a complementary hypothesis concerning the pathogenesis of multiple organ dysfunction syndrome. Crit Care Med1996; 24: 1107–1116.10.1097/00003246-199607000-00008Search in Google Scholar

5 Hennersdorf M, Perings C, Niebich V, Hillebrand S, Vester EG, Strauer BE. Chemoreflex sensitivity in patients with survived sudden cardiac arrest and prior myocardial infarction. Pacing Clin Electrophysiol2000; 23: 457–462.10.1111/j.1540-8159.2000.tb00827.xSearch in Google Scholar

6 La Rovere MT, Bigger TJ Jr, Marcus FI, Mortara A, Schwartz PJ, ATRAMI investigators. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. Lancet1998; 351: 478–484.10.1016/S0140-6736(97)11144-8Search in Google Scholar

7 Moerer O, Schmid A, Hofmann M, et al. Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med2002; 28: 1440–1446.10.1007/s00134-002-1429-9Search in Google Scholar PubMed

8 Nolan J, Batin PD, Andrews R, et al. Prospective study of heart rate variability and mortality in chronic heart failure – results of the United Kingdom Heart Evaluation and Assessment of Risk Trial (UK-HEART). Circulation1998; 98: 1510–1516.10.1161/01.CIR.98.15.1510Search in Google Scholar

9 Pikkujämsä SM, Mäkikallio TH, Sourander LB, et al. Cardiac interbeat interval dynamics from childhood to senescence. Comparison of conventional and new measures based on fractals and chaos theory. Circulation1999; 100: 393–399.10.1161/01.CIR.100.4.393Search in Google Scholar PubMed

10 Ponikowski P, Chua TP, Piepoli M, et al. Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. Circulation1997; 96: 2586–2594.10.1161/01.CIR.96.8.2586Search in Google Scholar PubMed

11 Schmidt H, Hennen R, Keller A, et al. Association of statin therapy and increased survival in patients with multiorgan dysfunction syndrome. Intensive Care Med2006; 32: 1248–1251.10.1007/s00134-006-0246-ySearch in Google Scholar PubMed

12 Schmidt H, Müller-Werdan U, Hoffmann T, et al. Autonomic dysfunction predicts mortality in patients with multiple organ dysfunction syndrome of different age groups. Crit Care Med2005; 33: 1994–2002.10.1097/01.CCM.0000178181.91250.99Search in Google Scholar

13 Schmidt H, Müller-Werdan U, Nuding S, et al. Impaired chemoreflex sensitivity in adult patients with multiple organ dysfunction syndrome – the potential role of disease severity. Intensive Care Med2004; 30: 665–672.10.1007/s00134-003-2131-2Search in Google Scholar PubMed

14 Schmidt H, Werdan K, Müller-Werdan U. Autonomic dysfunction in the ICU patient. Curr Opin Crit Care2001; 7: 314–322.10.1097/00075198-200110000-00002Search in Google Scholar PubMed

15 Smyth H, Sleight P, Pickering G. Reflex regulation of arterial pressure during sleep in man. Circ Res1969; 24: 109–121.10.1161/01.RES.24.1.109Search in Google Scholar

16 Winchell RJ, Hoyt DB. Spectral analysis of heart rate variability in the ICU. J Surg Res1996; 63: 11–16.10.1006/jsre.1996.0214Search in Google Scholar PubMed

Published Online: 2006-10-25
Published in Print: 2006-10-01

©2006 by Walter de Gruyter Berlin New York

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