Long-term HRV in critically ill pediatric patients: coma versus brain death

Abstract

Dysfunctions of the autonomic nervous system in critically ill patients with Acute Brain Injury (ABI) lead to changes in Heart Rate Variability (HRV) which appear to be particularly marked in patients subsequently declared in Brain Death (BD). HRV series are non-stationary, exhibit long memory in the mean and time-varying conditional variance (volatility), characteristics that are well modeled by AutoRegressive Fractionally Integrated Moving Average (ARFIMA) models with Generalized AutoRegressive Conditional Heteroscedastic (GARCH) errors. The long memory is estimated by the parameter d of the ARFIMA-GARCH model, whilst the time-varying conditional variance parameters, u and v characterize, respectively, the short-range and the persistence in the conditional variance. In this work, the ARFIMA-GARCH approach is applied to HRV series of 15 pediatric patients with ABI admitted in a pediatric intensive care unit, 5 of which has BD confirmed and 9 patients survived. The long memory and time-varying conditional variance parameters estimated by ARFIMA-GARCH modeling significantly differ between groups and seem able to contribute to characterize disease severity in children with ABI.