Autonomic Activity in Trauma Patients Based on Variability of Heart Rate and Respiratory Rate

    This article proves to the medical profession that Ansar's technology does indeed measure what we say it is measuring. The importance of this is, as you know, that the medical profession is extremely reluctant to change. The process of acceptance, as you can imagine, was highly politically charged. This article, as the medical profession has recognized signals a significant change, including a paradigm shift, within the field of medicine. Dr. Shoemaker, on Ansar's behalf and without compensation (except for the notoriety of his name in print on a seminal article), has fought the fight to get the article accepted for publication.

ANS Monitoring Abstract
Paymon Fathizadeh, MD
(fellow of Dr. Shoemaker)

Objective: To study the sympathetic (SNS) and parasympathetic nervous system (PSNS) activity and hemodynamic parameters in acute emergency patients with mild to moderately severe trauma.

Setting: Fourteen trauma patients studied immediately after admission to the emergency department (ED) in a level 1 university-run trauma service.

Methods: We measured heart rate (HR) and respiratory rate (RR) variability by spectral analysis in the early period of mildly to moderately injured patients. We studied the patterns of the low (Lfa), and high frequency (Hfa) areas of variability. The Lfa is the area under the spectral analysis curve within the frequency range of 0.04 to 0.10 Hz. This area reflects primarily the tone of the sympathetic nervous system as mediated by the cardiac nerve. The respiratory, or high frequency area (Hfa) is a 0.12 Hz-wide frequency range centered around the fundamental respiratory frequency (FRF) defined by the peak mode of the respiratory power spectrum. It is indicative of vagal outflow reflecting parasympathetic nervous system activity. The Lfa/Hfa, or "(L/R) ratio," reflects the balance between the sympathetic and parasympathetic nervous systems. The hemodynamic activities during bursts of autonomic activity in response to injury were explored by HR and RR variability measured with noninvasive hemodynamic monitoring consisting of bioimpedance cardiac output, HR, and mean arterial pressure (MAP) to measure cardiac function and transcutaneous oxygen (PtcCh) to reflect tissue perfusion.

Results: During sudden surges of autonomic activity, we observed increased Lfa, and to a lesser degree increased Hfa. Slightly later there was increased HR, mean arterial pressure (MAP), and cardiac index (CI), but decreased tissue perfusion indicated by the decreased PtcC^/FiCh ratio.

Conclusions: Surges in autonomic activity in the period immediately after ED admission of trauma patients can be potential indicators of significant hemodynamic activities.