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Campanaro CK, Nethery DE, Guo F, Kaffashi F, Loparo KA, Jacono FJ, Dick TE, Hsieh YH. Dynamics of ventilatory pattern variability and Cardioventilatory Coupling during systemic inflammation in rats. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1038531. [PMID: 37583625 PMCID: PMC10423997 DOI: 10.3389/fnetp.2023.1038531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/20/2023] [Indexed: 08/17/2023]
Abstract
Introduction: Biometrics of common physiologic signals can reflect health status. We have developed analytics to measure the predictability of ventilatory pattern variability (VPV, Nonlinear Complexity Index (NLCI) that quantifies the predictability of a continuous waveform associated with inhalation and exhalation) and the cardioventilatory coupling (CVC, the tendency of the last heartbeat in expiration to occur at preferred latency before the next inspiration). We hypothesized that measures of VPV and CVC are sensitive to the development of endotoxemia, which evoke neuroinflammation. Methods: We implanted Sprague Dawley male rats with BP transducers to monitor arterial blood pressure (BP) and recorded ventilatory waveforms and BP simultaneously using whole-body plethysmography in conjunction with BP transducer receivers. After baseline (BSLN) recordings, we injected lipopolysaccharide (LPS, n = 8) or phosphate buffered saline (PBS, n =3) intraperitoneally on 3 consecutive days. We recorded for 4-6 h after the injection, chose 3 epochs from each hour and analyzed VPV and CVC as well as heart rate variability (HRV). Results: First, the responses to sepsis varied across rats, but within rats the repeated measures of NLCI, CVC, as well as respiratory frequency (fR), HR, BP and HRV had a low coefficient of variation, (<0.2) at each time point. Second, HR, fR, and NLCI increased from BSLN on Days 1-3; whereas CVC decreased on Days 2 and 3. In contrast, changes in BP and the relative low-(LF) and high-frequency (HF) of HRV were not significant. The coefficient of variation decreased from BSLN to Day 3, except for CVC. Interestingly, NLCI increased before fR in LPS-treated rats. Finally, we histologically confirmed lung injury, systemic inflammation via ELISA and the presence of the proinflammatory cytokine, IL-1β, with immunohistochemistry in the ponto-medullary respiratory nuclei. Discussion: Our findings support that NLCI reflects changes in the rat's health induced by systemic injection of LPS and reflected in increases in HR and fR. CVC decreased over the course to the experiment. We conclude that NLCI reflected the increase in predictability of the ventilatory waveform and (together with our previous work) may reflect action of inflammatory cytokines on the network generating respiration.
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Affiliation(s)
- Cara K. Campanaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - David E. Nethery
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Fei Guo
- Institute for Smart, Secure and Connected Systems (ISSACS), Case Western Reserve University, Cleveland, OH, United States
| | - Farhad Kaffashi
- Institute for Smart, Secure and Connected Systems (ISSACS), Case Western Reserve University, Cleveland, OH, United States
| | - Kenneth A. Loparo
- Institute for Smart, Secure and Connected Systems (ISSACS), Case Western Reserve University, Cleveland, OH, United States
| | - Frank J. Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Thomas E. Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, United States
| | - Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Pasquini L, Noohi F, Veziris CR, Kosik EL, Holley SR, Lee A, Brown JA, Roy ARK, Chow TE, Allen I, Rosen HJ, Kramer JH, Miller BL, Saggar M, Seeley WW, Sturm VE. Dynamic autonomic nervous system states arise during emotions and manifest in basal physiology. Psychophysiology 2023; 60:e14218. [PMID: 36371680 PMCID: PMC10038867 DOI: 10.1111/psyp.14218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/15/2022]
Abstract
The outflow of the autonomic nervous system (ANS) is continuous and dynamic, but its functional organization is not well understood. Whether ANS patterns accompany emotions, or arise in basal physiology, remain unsettled questions in the field. Here, we searched for brief ANS patterns amidst continuous, multichannel physiological recordings in 45 healthy older adults. Participants completed an emotional reactivity task in which they viewed video clips that elicited a target emotion (awe, sadness, amusement, disgust, or nurturant love); each video clip was preceded by a pre-trial baseline period and followed by a post-trial recovery period. Participants also sat quietly for a separate 2-min resting period to assess basal physiology. Using principal components analysis and unsupervised clustering algorithms to reduce the second-by-second physiological data during the emotional reactivity task, we uncovered five ANS states. Each ANS state was characterized by a unique constellation of patterned physiological changes that differentiated among the trials of the emotional reactivity task. These ANS states emerged and dissipated over time, with each instance lasting several seconds on average. ANS states with similar structures were also detectable in the resting period but were intermittent and of smaller magnitude. Our results offer new insights into the functional organization of the ANS. By assembling short-lived, patterned changes, the ANS is equipped to generate a wide range of physiological states that accompany emotions and that contribute to the architecture of basal physiology.
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Affiliation(s)
- Lorenzo Pasquini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Fatemeh Noohi
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christina R. Veziris
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Eena L. Kosik
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sarah R. Holley
- San Francisco State University, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Alex Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jesse A. Brown
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Ashlin R. K. Roy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Tiffany E. Chow
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Isabel Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Joel H. Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Manish Saggar
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Virginia E. Sturm
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
- Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA, USA
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Mazloom R. A new approach for digestive disease diagnosis: Dynamics of gastrointestinal electrical activity. Med Hypotheses 2019; 128:64-68. [DOI: 10.1016/j.mehy.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/20/2019] [Accepted: 05/12/2019] [Indexed: 12/25/2022]
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Garrido D, Assioun JJ, Keshishyan A, Sanchez-Gonzalez MA, Goubran B. Respiratory Rate Variability as a Prognostic Factor in Hospitalized Patients Transferred to the Intensive Care Unit. Cureus 2018; 10:e2100. [PMID: 29581913 PMCID: PMC5866112 DOI: 10.7759/cureus.2100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Increasing mortality rates within the intensive care unit (ICU) is an ever growing problem, ultimately leading to increases in the cost of healthcare expenditures. Currently, there are attempts to use guidelines in the hospital setting to predict overall mortality in critically ill patients. However, a predictor of subsequent ICU admissions remains to be explored. Recent data has shown the importance of monitoring respiratory rate variability (RRV) as a useful predictor of the deterioration of patients. Respiratory rate, in comparison to blood pressure or pulse rate, is deemed as the better determinant in identifying high-risk patients. Aim Our study aims to assess the role of RRV monitoring as a potential prognostic marker predictive of ICU admission. Results There was a significant (p = 0.009) increase in RRV between the third and fourth set of respiratory rates prior to ICU admission, such that coefficient of variation percentage (CV%) increased from 0.3% (95% confidence interval (CI): 0.09 - 0.42) to 0.7% (95% CI: 0.04 - 0.9) about 12 hours before admission to the ICU independent from diagnosis. Conclusion Using elevated RRV as a signal may be a useful prognostic tool in providing early intervention, thus reducing the incidence of subsequent morbidity and mortality in patients that might necessitate an ICU admission.
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Affiliation(s)
| | | | | | | | - Bishoy Goubran
- Division of Clinical and Translational Research, Larkin Community Hospital
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Dhingra RR, Dutschmann M, Galán RF, Dick TE. Kölliker-Fuse nuclei regulate respiratory rhythm variability via a gain-control mechanism. Am J Physiol Regul Integr Comp Physiol 2016; 312:R172-R188. [PMID: 27974314 DOI: 10.1152/ajpregu.00238.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/14/2016] [Accepted: 12/11/2016] [Indexed: 11/22/2022]
Abstract
Respiration varies from breath to breath. On the millisecond timescale of spiking, neuronal circuits exhibit variability due to the stochastic properties of ion channels and synapses. Does this fast, microscopic source of variability contribute to the slower, macroscopic variability of the respiratory period? To address this question, we modeled a stochastic oscillator with forcing; then, we tested its predictions experimentally for the respiratory rhythm generated by the in situ perfused preparation during vagal nerve stimulation (VNS). Our simulations identified a relationship among the gain of the input, entrainment strength, and rhythm variability. Specifically, at high gain, the periodic input entrained the oscillator and reduced variability, whereas at low gain, the noise interacted with the input, causing events known as "phase slips", which increased variability on a slow timescale. Experimentally, the in situ preparation behaved like the low-gain model: VNS entrained respiration but exhibited phase slips that increased rhythm variability. Next, we used bilateral muscimol microinjections in discrete respiratory compartments to identify areas involved in VNS gain control. Suppression of activity in the nucleus tractus solitarii occluded both entrainment and amplification of rhythm variability by VNS, confirming that these effects were due to the activation of the Hering-Breuer reflex. Suppressing activity of the Kölliker-Fuse nuclei (KFn) enhanced entrainment and reduced rhythm variability during VNS, consistent with the predictions of the high-gain model. Together, the model and experiments suggest that the KFn regulates respiratory rhythm variability via a gain control mechanism.
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Affiliation(s)
- Rishi R Dhingra
- Department of Neurosciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mathias Dutschmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; and
| | - Roberto F Galán
- Department of Electrical Engineering and Computer Science, School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Thomas E Dick
- Department of Neurosciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; .,Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
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Seely AJE, Bravi A, Herry C, Green G, Longtin A, Ramsay T, Fergusson D, McIntyre L, Kubelik D, Maziak DE, Ferguson N, Brown SM, Mehta S, Martin C, Rubenfeld G, Jacono FJ, Clifford G, Fazekas A, Marshall J. Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients? Crit Care 2014; 18:R65. [PMID: 24713049 PMCID: PMC4057494 DOI: 10.1186/cc13822] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/05/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Prolonged ventilation and failed extubation are associated with increased harm and cost. The added value of heart and respiratory rate variability (HRV and RRV) during spontaneous breathing trials (SBTs) to predict extubation failure remains unknown. Methods We enrolled 721 patients in a multicenter (12 sites), prospective, observational study, evaluating clinical estimates of risk of extubation failure, physiologic measures recorded during SBTs, HRV and RRV recorded before and during the last SBT prior to extubation, and extubation outcomes. We excluded 287 patients because of protocol or technical violations, or poor data quality. Measures of variability (97 HRV, 82 RRV) were calculated from electrocardiogram and capnography waveforms followed by automated cleaning and variability analysis using Continuous Individualized Multiorgan Variability Analysis (CIMVA™) software. Repeated randomized subsampling with training, validation, and testing were used to derive and compare predictive models. Results Of 434 patients with high-quality data, 51 (12%) failed extubation. Two HRV and eight RRV measures showed statistically significant association with extubation failure (P <0.0041, 5% false discovery rate). An ensemble average of five univariate logistic regression models using RRV during SBT, yielding a probability of extubation failure (called WAVE score), demonstrated optimal predictive capacity. With repeated random subsampling and testing, the model showed mean receiver operating characteristic area under the curve (ROC AUC) of 0.69, higher than heart rate (0.51), rapid shallow breathing index (RBSI; 0.61) and respiratory rate (0.63). After deriving a WAVE model based on all data, training-set performance demonstrated that the model increased its predictive power when applied to patients conventionally considered high risk: a WAVE score >0.5 in patients with RSBI >105 and perceived high risk of failure yielded a fold increase in risk of extubation failure of 3.0 (95% confidence interval (CI) 1.2 to 5.2) and 3.5 (95% CI 1.9 to 5.4), respectively. Conclusions Altered HRV and RRV (during the SBT prior to extubation) are significantly associated with extubation failure. A predictive model using RRV during the last SBT provided optimal accuracy of prediction in all patients, with improved accuracy when combined with clinical impression or RSBI. This model requires a validation cohort to evaluate accuracy and generalizability. Trial registration ClinicalTrials.gov NCT01237886. Registered 13 October 2010.
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Lee J, Fietkiewicz C. Pattern variability in a computational model of respiratory rhythm generation. BMC Neurosci 2012. [PMCID: PMC3403392 DOI: 10.1186/1471-2202-13-s1-p139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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