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Autonomic control of heart rate after brain injury in children

B Goldstein1, M H Kempski, D DeKing

  • 1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Strong Children's Critical Care Center, NY, USA.

Critical Care Medicine
|February 1, 1996
PubMed

Insights

Autonomic nervous system dysfunction in children with acute brain injury is linked to injury severity and patient outcomes. Heart rate variability and catecholamine levels can help assess injury severity and predict prognosis.

Area of Science:

  • Pediatric critical care medicine
  • Neuroscience
  • Autonomic nervous system research

Background:

  • Acute brain injury in children can significantly impact autonomic nervous system (ANS) function.
  • Assessing the severity of neurologic dysfunction and predicting patient outcomes in pediatric acute brain injury remains challenging.
  • Understanding ANS alterations is crucial for improving patient management and prognosis.

Purpose of the Study:

  • To investigate sequential changes in physiological parameters including heart rate, respiratory rate, blood pressure, heart rate power spectra, and plasma catecholamine concentrations.
  • To correlate these physiological variables with the severity of neurologic dysfunction and patient outcomes in pediatric acute brain injury.
  • To explore the potential of these measurements as adjuncts in determining injury severity, prognosis, and even brain death.

Main Methods:

  • A prospective clinical study was conducted in a pediatric intensive care unit.
  • Thirty-seven pediatric patients with acute brain injury from various causes were enrolled.
  • Measurements included heart rate power spectra analysis and plasma catecholamine concentrations.

Main Results:

  • Significant associations were found between low-frequency heart rate power and the severity of neurologic dysfunction (Glasgow Coma Scale) and patient outcome (Glasgow Outcome Scale).
  • Low-frequency heart rate power and high-frequency heart rate power predicted survival likelihood.
  • Brain-dead patients exhibited significantly decreased low-frequency heart rate power and plasma catecholamine levels (norepinephrine, epinephrine, dopamine) compared to non-brain-dead patients.

Conclusions:

  • Autonomic nervous system control of heart rate is disrupted in proportion to the degree of neurologic insult in children with acute brain injury.
  • Heart rate power spectral analysis and plasma catecholamine concentrations show promise as adjuncts for assessing neurologic injury severity and prognosis in pediatric brain injury.
  • These techniques may also assist in the determination of brain death in pediatric patients.
Abstract

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