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Doctoral Thesis
DOI
Document
Author
Full name
José Carlos Bonjorno Júnior
Institute/School/College
Knowledge Area
Date of Defense
Published
São Carlos, 2018
Supervisor
Committee
Silva, Audrey Borghi e (President)
Gaspar, Gilberto Gambero
Olenscki, Daniela Kuguimoto Andaku
Montagnoli, Arlindo Neto
Roscani, Meliza Goi
Title in Portuguese
Análise de sinais biológicos por meio da cardioimpedância, da variabilidade da frequência cardíaca e de imagens ultrassonográficas da artéria braquial como ferramentas não invasivas precoces na sepse: um estudo prospectivo
Keywords in Portuguese
Endotélio
Frequência cardíaca
Sepse
Sistema nervoso autonômico
Abstract in Portuguese
Nesta tese, medidas hemodinâmicas como o débito cardíaco (DC), o volume sistólico (VS) não invasivo, os índices representativos da modulação vagal (RMSSD e SD1), a VFC total (SD2) e a função endotelial por meio da vasodilatação mediada por fluxo (FMD) da artéria braquial (%FMD) foram estudados nas primeiras 24h do diagnóstico de sepse. Foram avaliados 60 pacientes e acompanhados até o 28° dia. O DC e o VS foram obtidos batimento a batimento por meio da cardioimpedância. Os intervalos RR foram captados por um monitor cardíaco e transferidos para um software para processamento dos índices de VFC. O ultrassom Doppler foi utilizado para avaliar a % da FMD. Os resultados mostraram que 65% dos pacientes foram a óbito. No grupo não sobrevivente (GNS) foram observados menores valores de VS, RMSSD, SD1, índice triangular de RR, e SD2, bem como maiores valores de FC (P<0,05). Além disso, observamos que a %FMD apresentou-se reduzida para este grupo (GNS). Os índices RMSSD e SD1 foram preditores da %FMD, delta FMD e FMDpico. Valores de corte de RMSSD<11,2, SOFA>9 e %FMD>2,9 foram preditores de risco de morte em pacientes com sepse. Os dados sugerem que os índices representativos da modulação vagal, assim como a função vascular precoce podem ser marcadores de mortalidade na sepse.
Title in English
Analysis of biological signs by cardioimpedance, heart rate variability and ultrasound images of the brachial artery as early noninvasive tools in sepsis: a prospective study
Keywords in English
Autonomic nervous system
Endothelium
Heart rate
Sepsis
Abstract in English
In this thesis, hemodynamic measures such as cardiac output (DC), noninvasive stroke volume (SV), indices representative of vagal modulation (RMSSD and SD1), total HRV (SD2) and endothelial function through by flow mediated dilation (FMD) of the brachial artery (% FMD) were studied in the first 24 hours of the diagnosis of sepsis. Sixty patients were evaluated and followed up until the 28th day. The CO and SV were obtained beat-to-beat by cardio-impedance method. The RR intervals were captured by a cardiac monitor and transferred to a software for processing the HRV indices. Doppler ultrasound was used to evaluate the% of FMD. The results showed that 65% of the patients died. In the non-surviving group (NSG), lower values of SV, RMSSD, SD1, triangular index of RR, and SD2 were observed, as well as higher HR values (P<0.05). In addition, we observed that% FMD was reduced for this group (NSG). The RMSSD and SD1 indices were predictors of% FMD, delta FMD and peak of FMD. Cut-off values of RMSSD <11.2, SOFA> 9 and% FMD> 2.9 were predictors of death risk in patients with sepsis. The data suggest that representative indices of vagal modulation as well as early vascular function may be markers of mortality in sepsis.
 
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Publishing Date
2019-05-03
 
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