Impact of Heart Rate Variability on Anesthesia, Critical Care and Pain

Heart rate variability (HRV), is the change in time interval between consecutive heartbeats or inter-beat interval (IBI) due to heart-brain interactions and dynamic non-linear autonomic nervous system processes and indicates neuro-cardiac activity. Lower HRV has important perioperative implications and is an independent risk factor for all-cause and cardiovascular mortality and is linked with identified risk factors. HRV has a high predictive value in preoperative evaluation for post-operative morbidity and mortality. Diabetes-related autonomic neuropathy can be also predicted using HRV as a tool. HRV, as a part of a scoring system with respiratory rate, systolic blood pressure, and age was better than SOFA, NEWS, and MEWS in predicting 30-day mortality and better prognosticated ICU admission and intubation. Research has indicated the role of HRV in pediatrics to predict the severity of neurotrauma and recovery, dilated cardiomyopathy, and neonatal sepsis. The sensitivity of HRV to temperature, position, and stress as well as complex non-categorical values have inhibited its incorporation into routine clinical practice.