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Cardiovascular responses as predictors of mortality in children with acute brain injury
Marta João Silva1,2,3,4, Hernâni Gonçalves5,6, Rute Almeida5,7,6
1Pediatric Intensive Care Unit, São João University Hospital Center, Porto, Portugal. martajoaosilva@gmail.com.
Insights
Early heart rate and blood pressure changes, along with heart rate variability (HRV) measures like the Poincaré SD1/SD2 ratio, can predict mortality in children with severe acute acquired brain injury (ABI).
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Cardiovascular physiology
Background:
- Acute acquired brain injury (ABI) in children presents significant prognostic challenges.
- Cardiovascular responses (heart rate, blood pressure, heart rate variability) are potential indicators of neurological status and outcomes.
- Existing prognostic tools for pediatric ABI may not fully capture the dynamic physiological changes.
Purpose of the Study:
- To investigate the prognostic utility of cardiovascular parameters in children with severe ABI.
- To assess the association between heart rate (HR), blood pressure (BP), and heart rate variability (HRV) indices and mortality in pediatric patients with ABI.
- To compare the predictive value of cardiovascular measures with established prognostic factors.
Main Methods:
- Prospective observational cohort study in a tertiary academic pediatric intensive care unit (PICU).
- Inclusion criteria: Children (<18 years) with severe ABI surviving at least 12 hours post-PICU admission.
- Data collected: Physiological variables (HR, BP, HRV indices), neurological data, laboratory tests, medications, CT scans, and PICU scores within 12 hours of admission.
Main Results:
- Seventy-two children were included; 38.9% were diagnosed with brain death.
- Tachycardia, low systolic and mean blood pressure, and high diastolic blood pressure were significantly associated with mortality.
- The Poincaré SD1/SD2 ratio, a nonlinear HRV index, was significantly associated with mortality after adjusting for covariates.
Conclusions:
- Abnormal heart rate and blood pressure patterns in the early hours after admission are linked to mortality in children with severe ABI.
- The Poincaré SD1/SD2 ratio shows promise as a novel prognostic tool for predicting mortality in this vulnerable population.
- Larger, multicenter studies are needed to validate these findings and establish clinical utility.
Background:
Investigate the utility of cardiovascular responses such as heart rate (HR), blood pressure (BP), and heart rate variability (HRV) in the prognosis of children with acute acquired brain injury (ABI).
Methods:
Children under 18 years with severe acute acquired brain injury (ABI) who survived at least 12 h after PICU admission were included in a prospective observational cohort in a tertiary academic PICU. Physiological variables, neurological data, laboratory tests (chemistry and hematology), and medications were recorded within 12 h of admission. Linear and nonlinear HRV indices, CT scans, PICU scores, and survival rates were evaluated.
Results:
Seventy-two children, median age 10.7 years (IQR 4.1-13.6), were eligible for the study; 28 (38.9%) were diagnosed with brain death (BD). Tachycardia, SBP and MBP < 5th percentile, and MBP and DBP> 99th percentile were significantly associated with mortality. Poincaré SD1/SD2 was significantly associated with mortality after adjusting for age, sex and ongoing medication.
Conclusion:
Tachycardia, systolic hypotension and median hypo and hypertension were associated to mortality in children with severe ABI. While further validation through larger, multicenter studies is necessary, the Poincaré SD1/SD2 ratio has shown promise as a prognostic tool for predicting mortality in children with severe ABI.
Impact Statement:
This study explores cardiovascular changes, including heart rate and blood pressure, and linear/nonlinear HRV measures using ECG at 1000 Hz, and compare them with other prognostic factors like brain tomography and PICU scores. Tachycardia, hypo/hypertension in the early hours after admission are linked to early mortality in children with severe traumatic and non-traumatic brain injury. Linear/non-linear measures of HRV were also related to survival. Higher HRV values indicating better survival chances. We identified Poincaré SD1/SD2 ratio as a promising tool for predicting mortality in children with severe ABI.
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