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.
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.
Study Type
OBSERVATIONAL
Enrollment
60
24h ECG monitoring
The usual biological tests necessary for the management of the child and the addition of 1 tube of 2 ml
Chu de Saint-Etienne
Saint-Etienne, France
RECRUITINGKinetic of the HF(High Frequency) index (ms2/Hz) of heart rate variability
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.
Time frame: Through discharge from the ICU, an average of 15 days
Global activity indices (SDNN (Standard deviation of the NN (R-R) intervals) evaluation
Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis
Time frame: Through discharge from the ICU, an average of 15 days
Plot (Poincaré plot)) evaluation
Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis
Time frame: Through discharge from the ICU, an average of 15 days
Parasympathetic indices (pNN50 (Percentage of successive RR intervals that differ by more than 50 ms) evaluation
Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis
Time frame: Through discharge from the ICU, an average of 15 days
Parasympathetic indices RMSSD (Root mean square of successive RR interval differences) evaluation
Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis
Time frame: Through discharge from the ICU, an average of 15 days
Parasympathetic indices HF (High Frequency) evaluation
Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis
Time frame: Through discharge from the ICU, an average of 15 days
Sympathetic indices (LF, LF/HF ratio) evaluation
Measured continuously in quiet sleep at night, by temporal, geometric, frequency, fractal and entropy analysis
Time frame: Through discharge from the ICU, an average of 15 days
Evolution of biological markers of inflammation: CRP (C-reactive protein) (mg/L)
Collection of blood sampling for analysis
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Evolution of biological markers of inflammation : Procalcitonin (ng/mL)
Collection of blood sampling for analysis
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Evolution of biological markers of inflammation : Leukocytes (G/L)
Collection of blood sampling for analysis
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Evolution of biological markers of inflammation : Ferritin (µg/L)s
Collection of blood sampling for analysis
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Evolution of biological markers of inflammation : Fibrinogen (g/L)
Collection of blood sampling for analysis
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Evolution of biological markers of inflammation : Platelets (G/L)
Collection of blood sampling for analysis
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Evolution of biological markers of inflammation : Triglycerides (g/L)
Collection of blood sampling for analysis
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Interferon alpha, interferon beta and interferon gamma.
Analysed by Luminex from blood sample (pg/mg)
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Tumor Necrosis Factor (TNF)
Analysed by Luminex from blood sample (pg/ml)
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Interleukines (IL1, IL2, IL3; IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL11, IL12, IL13)
Analysed by Luminex from blood sample (pg/ml)
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Presence or absence of virus in blood
PCR (Polymerase chain reaction) multiplex
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Presence or absence of bacteria in blood
Blood cultures
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Presence or absence of bacteria in bone-marrow
Lumbar puncture
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
Presence or absence of bacteria in urine
cytobacteriological examination of urine
Time frame: Day : 1, at discharge from the ICU, an average of 90 days
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