Impaired chemoreflex sensitivity in adult patients with multiple organ dysfunction syndrome--the potential role of disease severity

Intensive Care Med (2004) 30:665672

DOI 10.1007/s00134-003-2131-2 ORIGINALHendrik Schmidt

Ursula Mller-Werdan

Sebastian Nuding

Thomas Hoffmann

Darrel P. FrancisDirk HoyerMathias Rauchhaus

Karl WerdanImpaired chemoreflex sensitivity

in adult patients with multiple organ

dysfunction syndromethe potential role

of disease severityReceived: 18 June 2002Accepted: 14 November 2003

Published online: 12 February 2004

Springer-Verlag 2004H. Schmidt ()) U. Mller-Werdan S. Nuding T. Hoffmann M. Rauchhaus K. WerdanUniversity Department of Medicine III,

Klinikum Krllwitz,Martin-Luther-UniversityHalle-Wittenberg, Ernst-Grube-Strasse 40,

06097 Halle/Saale, Germanye-mail:

[email protected]

Tel.: [phone]Fax: [phone]M. RauchhausDepartment of Cardiology

at Campus Virchow-Klinikum (CVK),

Charit, University Medicine Berlin,

Augustenburger Platz 1, 13353 Berlin,

GermanyD. P. FrancisNational Heart and Lung Institute,

Heart Failure Unit,Royal Brompton Hospital,Dovehouse Street, London, SW3 6LY, UKD. HoyerInstitute of Pathophysiology,

Friedrich-Schiller-University Jena,

Nonnenplan, 07740 Jena, GermanyAbstract Objective: The cardiac

chemoreflex sensitivity is a powerful

predictor of autonomic dysfunction in

chronic heart failure and after myocardial infarction. The objective of

the present study was to characterize

cardiac chemoreflex sensitivity in

patients with multiple organ dysfunction syndrome (MODS). We also

aimed to elucidate the effect of the

severity of MODS on the assessment

of cardiac chemoreflex sensitivity.

Design: Prospective cohort study.

Setting: Twelve-bed medical intensive care unit in a university center.

Patients: Forty consecutively admitted patients with MODS during a

7-month period. Patients with MODS

were identified by an APACHE II

score of 20 or more. Sepsis was

defined as a Sepsis Score, according

to Elebute and Stoner, of 12 or more.

Interventions: The cardiac chemoreflex sensitivity was assessed using the

regression of heart interval (ms) versus arterial oxygen pressure (mmHg).

Measurements and results: First, we

established a new method to assess

cardiac chemoreflex sensitivity and

applied it to healthy controls and

patients. Second, we found that cardiac chemoreflex sensitivity correlated with the severity of MODS as

calculated by the APACHE II score

(r2=0.34, p=0.001). This relation was

best fitted by a model including

minimum heart rate and standard

bicarbonate in 24 h (r2=0.5, p<0.001)

and Glasgow Coma Scale (r2=0.5,p=0.005). Age, however, did not

significantly contribute (r2=0.001,p=0.8). Conclusions: The calculation

of cardiac chemoreflex sensitivity

enabled us to quantify an important

component of the cardiorespiratory

interactions in patients with MODS.

Severity of illness was a more pronounced determinant of impaired

cardiac chemoreflex sensitivity than

age. The quantification of the cardiorespiratory interactions by measuring the cardiac...