Abstract

Objective:

In this study, the purpose was to determine the changes in the activity of the autonomic nervous system by analyzing the parameters of heart rate variability (HRV) among patients who underwent invasive mechanical ventilation.

Materials and Methods:

A total of 83 patients who had been followed up in the intensive care unit for at least 24 h, without a diagnosis of any known heart disease or arrhythmia, and aged over 18 years were included in the study. Mechanically ventilated patients were included in group M (n=41) and others in group K (n=42). The electrocardiography (ECGs) of the patients was recorded for 24 h through a Holter device, which records ambulatory ECG with 3 channels.

Results:

There was no significant difference between the groups regarding the HRV parameters, atrial arrhythmia numbers, heart rates, RR interval times, as well as intervals of QT and QTc. It was found that the number of ventricular arrhythmias was significantly higher in the mechanically ventilated group compared to the non-mechanically ventilated group (p=0.0083).

Conclusion:

In conclusion, based on the results of this study, we believe that invasive mechanical ventilation did not lead to changes in the HRV parameters of the patients who were hemodynamically stable without any cardiac disease.

Keywords: Ventilation, respiration, intensive care unit, heart rate, electrocardiography

References

  1. Pinsky MR. Cardiovascular issues in respiratory care. Chest 2005;128(5 Suppl 2):592S-7S.
  2. Frazier SK. Cardiovascular effects of mechanical ventilation and weaning. Nurs Clin North Am 2008;43:1-15;v.
  3. Kleiger RE, Stein PK, Bigger JT Jr. Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol 2005;10:88-101.
  4. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996;93:1043-65.
  5. Dogru T, Gunaydın S, Simsek V, Tulmac M, Guneri M. The relationship between the QT interval and autonomous and anthropometric features. Turk Kardiyoloji Dernegi Arsivi 2007;35.4:216-26.
  6. Akselrod S, Gordon D, Ubel FA, Shannon DC, Berger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 1981;213:220-2.
  7. Houle MS, Billman GE. Low-frequency component of the heart rate variability spectrum: a poor marker of sympathetic activity. Am J Physiol 1999;276:H215-23.
  8. Martelli D, Silvani A, McAllen RM, May CN, Ramchandra R. The low frequency power of heart rate variability is neither a measure of cardiac sympathetic tone nor of baroreflex sensitivity. Am J Physiol Heart Circ Physiol 2014;307:H1005-12.
  9. De Meersman RE, Reisman SS, Daum M, Zorowitz R, Leifer M, Findley T. Influence of respiration on metabolic, hemodynamic, psychometric, and R-R interval power spectral parameters. Am J Physiol 1995;269(4 Pt 2):H1437-40.
  10. Rahman F, Pechnik S, Gross D, Sewell L, Goldstein DS. Low frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Clin Auton Res 2011;21:133-41.
  11. Malliani A. Heart rate variability: from bench to bedside. Eur J Intern Med 2005;16:12-20.
  12. Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol 2013;4:26.
  13. Macefield VG. Sustained activation of muscle sympathetic outflow during static lung inflation depends on a high intrathoracic pressure. J Auton Nerv Syst 1998;68:135-9. 
  14. Macefield VG, Wallin BG. Effects of static lung inflation on sympathetic activity in human muscle nerves at rest and during asphyxia. J Auton Nerv Syst 1995;53:148-56.
  15. Garet M, Barthélémy JC, Degache F, Pichot V, Duverney D, Roche F. Modulations of human autonomic function induced by positive pressure-assisted breathing. Clin Physiol Funct Imaging 2006;26:15-20.
  16. Karmali SN, Sciusco A, May SM, Ackland GL. Heart rate variability in critical care medicine: a systematic review. Intensive Care Med Exp 2017;5:33.
  17. Thungtong A, Knoch MF, Jacono FJ, Dick TE, Loparo KA. Periodicity: A Characteristic of Heart Rate Variability Modified by the Type of Mechanical Ventilation After Acute Lung Injury. Front Physiol 2018;9:772.
  18. Elinoff J, Talmor D, Subramaniam B, Karmpaliotis D, Goldberger AL, Malhotra A. Effects of mechanical ventilation on the electrocardiogram in adults. Lung 2008;186:219.
  19. Bubshait K, Alabbasi Y. Influence of Spontaneous and Mechanical Ventilation on Frequency-Based Measures of Heart Rate Variability. Crit Care Res Pract 2021;2021:8709262.
  20. Nagaraj SB, McClain LM, Zhou DW, Biswal S, Rosenthal ES, Purdon PL, et al. Automatic Classification of Sedation Levels in ICU Patients Using Heart Rate Variability. Crit Care Med 2016;44:e782-9.
  21. Unoki T, Grap MJ, Sessler CN, Best AM, Wetzel P, Hamilton A, et al. Autonomic nervous system function and depth of sedation in adults receiving mechanical ventilation. Am J Crit Care 2009;18:42-50; quiz 51.
  22. Kasaoka S, Nakahara T, Kawamura Y, Tsuruta R, Maekawa T. Real-time monitoring of heart rate variability in critically ill patients. J Crit Care 2010;25:313-6.
  23. Güntzel Chiappa AM, Chiappa GR, Cipriano G Jr, Moraes RS, Ferlin EL, Borghi-Silva A, et al. Spontaneous breathing trial in T-tube negatively impact on autonomic modulation of heart rate compared with pressure support in critically ill patients. Clin Respir J 2017;11:489-95.
  24. Crescimanno G, Greco F, Arrisicato S, Morana N, Marrone O. Effects of positive end expiratory pressure administration during non-invasive ventilation in patients affected by amyotrophic lateral sclerosis: A randomized crossover study. Respirology 2016;21:1307-13.
  25. Guerra M, Igreja TP, de Carvalho TD, Valenti VE, de Abreu LC, da Silva TD, et al. Heart Rate Variability During Weaning Mechanical Ventilation. Journal of Cardiology and Therapy 2016;3:519-23.
  26. Huang CT, Tsai YJ, Lin JW, Ruan SY, Wu HD, Yu CJ. Application of heart-rate variability in patients undergoing weaning from mechanical ventilation. Crit Care 2014;18:R21.
  27. Kaymak C, Dogru T, Basar H. The evaluation of Qtc interval, Qtc dispersion, dysrhythmia and heart rate variability undergoing sevoflurane and desflurane anesthesia in laporoscopic surgery. Turk J Anaesthesiol Reanim 2007;35:57-63.
  28. Arai K, Nakagawa Y, Iwata T, Horiguchi H, Murata K. Relationships between QT interval and heart rate variability at rest and the covariates in healthy young adults. Auton Neurosci 2013;173:53-7.
  29. Meng L, Shivkumar K, Ajijola O. Autonomic Regulation and Ventricular Arrhythmias. Curr Treat Options Cardiovasc Med 2018;20:38.
  30. Shen MJ, Zipes DP. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circ Res 2014;114:1004-21.
  31. Stauss HM. Heart rate variability. Am J Physiol Regul Integr Comp Physiol 2003;285:R927-31.

Copyright and license

Copyright © 2023 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Yarımoğlu R, Kaymak Ç, Özcan NN, Murat SN, Başar H, Özcan A, et al. Analysis of Heart Rate Variability in Patients Undergoing Mechanical Ventilation. Turk J Intensive Care. 2023;21(1):33-40. https://doi.org/10.4274/tybd.galenos.2022.95914