期刊
JOURNAL OF CRITICAL CARE
卷 28, 期 6, 页码 1093-1098出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jcrc.2013.08.022
关键词
Electrocardiography; Entropy; Heart rate; Nonlinear dynamics; Wounds and injuries; Iraq War 2003
资金
- Comprehensive Intensive Care Research Task Area, Combat Casualty Care Research Area Directorate, US Army Medical Research and Materiel Command, Ft. Detrick, MD
- Wyss Institute for Biologically Inspired Engineering
- G. Harold and Leila Y. Mathers Charitable Foundation
- James S. McDonnell Foundation [R00AG030677]
- National Institutes of Health [R00AG030677]
Purpose: We found that heart rate (HR) complexity metrics such as sample entropy (SampEn) identified patients with trauma receiving lifesaving interventions (LSIs). We now aimed (1) to test a multiscale entropy (MSE) index, (2) to compare it to single-scale measures including SampEn, and (3) to assess different parameter values for calculation of SampEn and MSE. Methods: This was a study of combat casualties in an emergency department in Iraq. Electrocardiograms of 70 acutely injured adults were recorded. Twelve underwent LSIs and 58 did not. Lifesaving interventions included endotracheal intubation (9), tube thoracostomy (9), and emergency transfusion (4). From each electrocardiogram, a segment of 800 consecutive beats was selected. Offline, R waves were detected and R-to-R interval time series were generated. Sample entropy, MSE, and time-domain measures of HR variability (mean HR, SD, the proportion of pairs of consecutive NN intervals that differ by more than 20 and 50 milliseconds, square root of the mean of the squares of differences between adjacent NN intervals) were computed. Results: Differences in mean HR (LSI: 111 +/- 33, non-LSI: 90 +/- 17 beats/min) were not significant. Systolic arterial pressure was statistically but not clinically different (LSI: 123 +/- 19, non-LSI: 135 +/- 19 mm Hg). Sample entropy (LSI: 0.90 +/- 0.42, non-LSI: 1.19 +/- 0.35; P < .05) and MSE index (LSI: 2.58 +/- 2.55, non-LSI: 5.67 +/- 2.48; P < .001) differed significantly. Conclusions: Complexity of HR dynamics over a range of time scales was lower in high-risk than in low-risk combat casualties and outperformed traditional vital signs. Published by Elsevier Inc.
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