Heart rate variability as a marker of multiple organ dysfunction syndrome in deeply sedated, prepubescent patients: a secondary analysis

Multiple organ dysfunction syndrome (MODS) is a frequent complication in critically ill patients. The objective of the present study in a pediatric intensive care unit was to determine the feasibility of using HRV to differentiate between deeply sedated patients with medium/high MODS and those with no/low MODS. This was a secondary analysis of data from the ANI EP clinical study (NCT04913038). Various HRV indices were computed in a 10-minute time window. A patient with a pediatric Sequential Organ Failure Assessment (pSOFA) score higher than 5 was classified into the medium/high MODS group. Forty-seven patients were selected for analysis. The Energy variable (equivalent to the standard deviation of normal-to-normal intervals) was significantly correlated with the pSOFA score (r²=-0.31, p = 0.03). HFnu values were higher in the medium/high MODS group than in the no/low MODS group (0.35 vs. 0.28, respectively; p = 0.019), and HFnu discriminated between the two groups of patients with an area under the receiver operating characteristic curve of 0.75 (sensitivity = 0.78, specificity = 0.74). Energy was slightly but not significantly lower in the medium/high MODS group (0.17, vs. 0.35 in the no/mild MODS group; p = 0.086). The results of our study in a PICU showed that HRV indices can differentiate between deeply sedated patients with MODS and those without. Further investigations are needed to confirm this finding and extend it to other populations.