Autonomic Nervous System, Sepsis
Conditions
Keywords
Dysautonomia
Brief summary
The Autonomic Nervous System (ANS) regulates the inflammatory response in real time, just as it controls heart rate and other vital functions. Many studies have investigated induced stimulation of the vagus nerve and its therapeutic effect in inhibiting TNFα (Tumor Necrosis Factor alpha) secretion, and therefore the risk of hypotension, septic shock, organ dysfunction during inflammation. While the anti-inflammatory effect of the autonomic nervous system on inflammation has been well studied, conversely, the effect of major inflammation on the balance of the autonomic nervous system is more difficult to understand. The inflammatory reflex could be overwhelmed and the regulatory centers of the brainstem dysregulated during situations of extreme inflammation.
Detailed description
The purpose of this study is to follow the short-term evolution of sympathetic and parasympathetic markers of dysautonomia in children hospitalized in intensive care units for severe sepsis, to characterize the evolution of the different autonomic indices according to the site of infection (meningitis, pulmonary infection, organ failure, bacteraemia) and types of pathogens (viral, bacterial, atypical germs) and correlating the evolution of the various inflammation biomarkers and cytokines with the degree of dysautonomia.
Interventions
OTHERAmbulatory ECG
24h ECG monitoring
BIOLOGICALBlood sample
The usual biological tests necessary for the management of the child and the addition of 1 tube of 2 ml
Sponsors
Centre Hospitalier Universitaire de Saint Etienne
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
1 Days to 17 Years
Healthy volunteers
Yes
Inclusion criteria
for cases group : * Hospitalization in a pediatric intensive care unit. * Presenting the sepsis criteria * Patient affiliated or entitled to a social security scheme * Holders of parental authority having received informed information about the study and having signed the consent form
Exclusion criteria
for cases group : * Parents or legal guardians who do not speak French * Chronic or acute pathology that can alter autonomic balance (congenital heart disease, encephalopathy, neuropathy, acute pain, etc.) * Recent general anesthesia less than 48 hours old. (inclusion may be made beyond 48 hours from the last general anesthesia if the inclusion criteria remain present) * Taking treatments that can alter the ANS (β-blockers, etc.) or inflammation (NSAIDs, corticosteroids) Inclusion criteria for control group : * Patient affiliated or entitled to a social security scheme * Holders of parental authority having received informed information about the study and having signed the consent form
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Kinetic of the HF(High Frequency) index (ms2/Hz) of heart rate variability | Through discharge from the ICU, an average of 15 days | Measure of the HF index of heart rate continuously at the patient's bed, during a quiet sleep phase at night, day by day for the entire duration of hospitalization in the ICU. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Plot (Poincaré plot)) evaluation | Through discharge from the ICU, an average of 15 days | Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis |
| Parasympathetic indices (pNN50 (Percentage of successive RR intervals that differ by more than 50 ms) evaluation | Through discharge from the ICU, an average of 15 days | Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis |
| Parasympathetic indices RMSSD (Root mean square of successive RR interval differences) evaluation | Through discharge from the ICU, an average of 15 days | Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis |
| Parasympathetic indices HF (High Frequency) evaluation | Through discharge from the ICU, an average of 15 days | Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis |
| Sympathetic indices (LF, LF/HF ratio) evaluation | Through discharge from the ICU, an average of 15 days | Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis |
| Evolution of biological markers of inflammation: CRP (C-reactive protein) (mg/L) | Day : 1, at discharge from the ICU, an average of 90 days | Collection of blood sampling for analysis |
| Evolution of biological markers of inflammation : Procalcitonin (ng/mL) | Day : 1, at discharge from the ICU, an average of 90 days | Collection of blood sampling for analysis |
| Evolution of biological markers of inflammation : Leukocytes (G/L) | Day : 1, at discharge from the ICU, an average of 90 days | Collection of blood sampling for analysis |
| Evolution of biological markers of inflammation : Ferritin (µg/L)s | Day : 1, at discharge from the ICU, an average of 90 days | Collection of blood sampling for analysis |
| Global activity indices (SDNN (Standard deviation of the NN (R-R) intervals) evaluation | Through discharge from the ICU, an average of 15 days | Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis |
| Evolution of biological markers of inflammation : Platelets (G/L) | Day : 1, at discharge from the ICU, an average of 90 days | Collection of blood sampling for analysis |
| Evolution of biological markers of inflammation : Triglycerides (g/L) | Day : 1, at discharge from the ICU, an average of 90 days | Collection of blood sampling for analysis |
| Interferon alpha, interferon beta and interferon gamma. | Day : 1, at discharge from the ICU, an average of 90 days | Analysed by Luminex from blood sample (pg/mg) |
| Tumor Necrosis Factor (TNF) | Day : 1, at discharge from the ICU, an average of 90 days | Analysed by Luminex from blood sample (pg/ml) |
| Interleukines (IL1, IL2, IL3; IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL11, IL12, IL13) | Day : 1, at discharge from the ICU, an average of 90 days | Analysed by Luminex from blood sample (pg/ml) |
| Presence or absence of virus in blood | Day : 1, at discharge from the ICU, an average of 90 days | PCR (Polymerase chain reaction) multiplex |
| Presence or absence of bacteria in blood | Day : 1, at discharge from the ICU, an average of 90 days | Blood cultures |
| Presence or absence of bacteria in bone-marrow | Day : 1, at discharge from the ICU, an average of 90 days | Lumbar puncture |
| Presence or absence of bacteria in urine | Day : 1, at discharge from the ICU, an average of 90 days | cytobacteriological examination of urine |
| Evolution of biological markers of inflammation : Fibrinogen (g/L) | Day : 1, at discharge from the ICU, an average of 90 days | Collection of blood sampling for analysis |
Countries
France
Contacts
Primary ContactHUGUES PATURAL, MD-PHD
Backup ContactMARINE DUBOIS, Resident
Outcome results
None listed