ULTRA-EARLY AUTONOMIC DYSFUNCTION CHARACTERIZATION AFTER SEVERE TRAUMATIC BRAIN INJURY
Recommended Citation
Krishnamoorthy V, Wongsripuemtet P, Ohnuma T, Novak J, Dong K, Wang Z, Vavilala M, Miller JB. ULTRA-EARLY AUTONOMIC DYSFUNCTION CHARACTERIZATION AFTER SEVERE TRAUMATIC BRAIN INJURY. Crit Care Med 2026; 54(3S):1.
Document Type
Conference Proceeding
Publication Date
3-1-2026
Publication Title
Crit Care Med
Keywords
General & Internal Medicine
Abstract
Introduction: Heart rate variability (HRV) reflects the balance between sympathetic and parasympathetic activity; its imbalance indicates autonomic dysfunction (eAD), a common cardiovascular effect after traumatic brain injury (TBI). This study evaluates HRV metrics across sex and age groups during the first 24 hours of ICU admission in patients with severe TBI (sTBI). Methods: We conducted a secondary analysis of patients with sTBI enrolled in the BOOST-3, an ongoing clinical trial that began in 2019. We included sTBI patient who had available continuous hemodynamic waveform data. Time-synchronized lead II ECG signals were collected and segmented into five-minute epochs during the first 24 hours of ICU admission. We extracted key HRV indices: root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN). Descriptive statistics summarized the data, and group comparisons assessed differences in HRV metrics between males and females and across age groups. Correlations between age and HRV metrics were assessed using Pearson’s correlation coefficients. Results: This study included a total of 54 patients, the majority of whom were non-Hispanic White (50%), male (77.8%), and below the age of 45 (59.3%). The mean (SD) of GCS was 5.83(1.71). No statistically significant differences in HRV metrics were observed between sexes or age groups. Mean (SD) RMSSD was 48.55 ms (36.12) in males vs. 49.67 ms (33.87) in females (p = 0.894), and 53.46 ms (39.30) in patients < 45 vs. 42.71 ms (29.82) in those ≥45 (p = 0.259). Mean SDNN was 46.37 ms (29.11) in males vs. 47.56 ms (29.43) in females (p = 0.903); younger patients had higher SDNN (51.08 ms [31.73]) than older patients (41.48 ms [24.87], p = 0.219). Correlations between age and HRV metrics ranged from –0.107 to –0.236. Conclusions: No statistically significant differences in ultra early HRV metrics were observed by sex or age in adult sTBI patients. These findings highlight HRV metrics in sTBI population and underscore the need for further research to better evaluate the prognostic utility of HRV in this population.
Volume
54
Issue
3S
First Page
1
