Day-to-day progression of vital-sign circadian rhythms in the intensive care unit

Shaun Davidson,João Jorge,Mirae Harford,Peter Watkinson,Duncan Young,Mauricio Villarroel,Lionel Tarassenko,Eoin Finnegan

doi:10.1186/s13054-021-03574-w

Abstract

BackgroundDisrupted vital-sign circadian rhythms in the intensive care unit (ICU) are associated with complications such as immune system disruption, delirium and increased patient mortality. However, the prevalence and extent of this disruption is not well understood. Tools for its detection are currently limited.MethodsThis paper evaluated and compared vital-sign circadian rhythms in systolic blood pressure, heart rate, respiratory rate and temperature. Comparisons were made between the cohort of patients who recovered from the ICU and those who did not, across three large, publicly available clinical databases. This comparison included a qualitative assessment of rhythm profiles, as well as quantitative metrics such as peak–nadir excursions and correlation to a demographically matched ‘recovered’ profile.ResultsCircadian rhythms were present at the cohort level in all vital signs throughout an ICU stay. Peak–nadir excursions and correlation to a ‘recovered’ profile were typically greater throughout an ICU stay in the cohort of patients who recovered, compared to the cohort of patients who did not.ConclusionsThese results suggest that vital-sign circadian rhythms are typically present at the cohort level throughout an ICU stay and that quantitative assessment of these rhythms may provide information of prognostic use in the ICU.

Highlights

Disrupted vital-sign circadian rhythms in the intensive care unit (ICU) are associated with complications such as immune system disruption, delirium and increased patient mortality
We investigated the presence of circadian rhythms in systolic blood pressure (SBP), heart rate (HR), respiratory rate (RR) and temperature from the first day of admission to the ICU, comparing the cohort of patients who recovered to be discharged home with those who died or were discharged to hospice care
Differences in demographics between the SRV and DCS cohorts were smaller for Post-Intensive-Care Risk-adjusting Alerting and Monitoring (PICRAM) than for MIMIC-III and eICU-CRD, and their mean values were greater

Summary

Introduction

Disrupted vital-sign circadian rhythms in the intensive care unit (ICU) are associated with complications such as immune system disruption, delirium and increased patient mortality. Medical interventions to regulate vital signs, combined with patient trauma and a noisy and stressful ICU environment, can severely disrupt a patient’s circadian rhythm [1, 2]. Disrupted circadian rhythms in the ICU are linked to complications such as immune system disruption [3], delirium [4] and increased mortality [5]. Typical approaches rely upon sleep detection and staging. Typical sleep staging methods are too cumbersome to be used regularly by clinical staff in the ICU, can further disrupt patients, and are unreliable [9]. New methods are needed to quantify the level and nature of circadian rhythmicity

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Conclusion