Monitorização do sistema nervoso autônomo em ambiente de cuidados intensivos como ferramenta de prognóstico. Revisão sistemática

Luis Bento, Rui Fonseca-Pinto, Pedro Póvoa

To present a systematic review of the use of autonomic nervous system monitoring as a prognostic tool in intensive care units by assessing heart rate variability. Literature review of studies published until July 2016 listed in PubMed/Medline and conducted in intensive care units, on autonomic nervous system monitoring, via analysis of heart rate variability as a prognostic tool (mortality study). The following English terms were entered in the search field: ("autonomic nervous system" OR "heart rate variability") AND ("intensive care" OR "critical care" OR "emergency care" OR "ICU") AND ("prognosis" OR "prognoses" OR "mortality"). There was an increased likelihood of death in patients who had a decrease in heart rate variability as analyzed via heart rate variance, cardiac uncoupling, heart rate volatility, integer heart rate variability, standard deviation of NN intervals, root mean square of successive differences, total power, low frequency, very low frequency, low frequency/high frequency ratio, ratio of short-term to long-term fractal exponents, Shannon entropy, multiscale entropy and approximate entropy. In patients admitted to intensive care units, regardless of the pathology, heart rate variability varies inversely with clinical severity and prognosis.