期刊
CURRENT OPINION IN PEDIATRICS
卷 25, 期 2, 页码 172-179出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MOP.0b013e32835e8fe6
关键词
heart rate variability; ICU; neonate; predictive monitoring; prematurity; sepsis
类别
资金
- [NICHD 051609]
Purpose of review Predictive monitoring is an exciting new field involving analysis of physiologic data to detect abnormal patterns associated with critical illness. The first example of predictive monitoring being taken from inception (proof of concept) to reality (demonstration of improved outcomes) is the use of heart rate characteristics (HRC) monitoring to detect sepsis in infants in the neonatal ICU. The commercially available 'HeRO' monitor analyzes electrocardiogram data from existing bedside monitors for decreased HR variability and transient decelerations associated with sepsis, and converts these changes into a score (the HRC index or HeRO score). This score is the fold increase in probability that a patient will have a clinical deterioration from sepsis within 24 h. This review focuses on HRC monitoring and discusses future directions in predictive monitoring of ICU patients. Recent findings In a randomized trial of 3003 very low birthweight infants, display of the HeRO score reduced mortality more than 20%. Ongoing research aims to combine respiratory and HR analysis to optimize care of ICU patients. Summary Predictive monitoring has recently been shown to save lives. Harnessing and analyzing the vast amounts of physiologic data constantly displayed in ICU patients will lead to improved algorithms for early detection, prognosis, and therapy of critical illnesses.
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