Modulação autonômica cardíaca e a influência da noradrenalina frente à mobilização passiva em pacientes com choque séptico

Abstract

Introduction: Sepsis is currently one of the main causes of hospital death and when associated with the use of vasopressor medication and lactate> 2mol mmol / L is defined as septic shock. This patient has impairment in the sympathetic and parasympathetic autonomic nervous system (ANS). In addition, for these hospitalized and bedridden patients, passive mobilization is a widely used strategy, but there is still a lack of evidence on the association between vasoactive medication in the cardiac autonomic response. Objective: To investigate the presence of an association between vasoactive drugs and the response of cardiac autonomic modulation to passive mobilization in patients with septic shock. Methods: Prospective interventional study. The sample consisted of 16 individuals diagnosed with septic shock. The heart rate variability (HRV) indices were analyzed: DFA, PNS, BF / AF and RMSSD, in the pre, during and post mobilization moments, as well as the HRV variations (deltas: ∆mob-pre, ∆post-mob and (Post-pre). To verify the association between the use of noradrenaline and HRV, Spearman's correlation coefficient was used, with a significance level of 5% (p <0.05). Results: Correlations were found between noradrenaline and the HRV variation, as shown: negative correlations between 1. noradrenaline and the DFA1 index (r = -0.64; p = 0.009) and 2. Noradrenaline and BF / AF ratio (r = -0.49; p = 0.05) for post-premob delta and mob-pre delta, respectively. In addition to 3. positive correlations between noradrenaline and the PNS index (r = 0.54; p = 0.032) for mob-pre delta. Conclusion: noradrenaline is associated with the response of cardiac autonomic modulation to passive mobilization in patients with septic shock.